四维左房定量分析技术评估非瓣膜性房颤患者左房功能及其对左心耳血栓的预测价值

Application of four-dimensional left atrial quantitative analysis in evaluating the predictive value of left atrial function and its predictive value on left atrial appendage thrombosis in patients with non-valvular atrial fibrillation

目的探讨四维左房定量分析技术对非瓣膜性房颤患者左房功能的评估效果,并分析其对左心耳血栓的预测价值。方法选取108例非瓣膜性房颤患者作为研究对象,所有研究对象均经房颤中风风险评估系统评估后判断为血栓栓塞低风险,并根据患者是否发生血栓分为血栓组(n=12)及无血栓组(n=96)。测量并比较两组患者左房容积参数及左房应变等参数,采用logistic回归分析影响患者发生血栓相关因素,并采用受试者工作特征曲线(ROC)检验左房容积参数及应变参数对血栓栓塞低风险患者后期发生血栓的预测价值。结果血栓组左房整体射血分数(LAEF)、左房存储期纵向应变(LASr)、左房导管期纵向应变(LAScd)、左房收缩期纵向应变(LASct)、左房存储期圆周应变(LASr-c)、左房导管期圆周应变(LAScd-c)及左房收缩期圆周应变(LASct-c)明显低于无血栓组,左房最小容积(LAVmin)、左房最大容积(LAVmax)、左房收缩前容积(LAVpreA)及左房最大容积指数(LAVImax)明显高于无血栓组(t分别=-4.80、-3.88、-3.62、-3.77、-3.58、-2.24、-2.07、3.68、3.88、3.38、3.82,P均<0.05)。logistic分析结果显示LAVmax和LAVImax增高及LAEF、LASr和LASr-c均为影响血栓栓塞低风险患者发生血栓的相关因素(OR分别=2.14、2.35、0.66、0.35、0.66,P均<0.05)。经ROC曲线分析获得LAVmax、LAVImax、LAEF、LASr和LASr-c联合检测的曲线下面积(AUC)为0.97。结论四维左房定量分析技术可有效评估非瓣膜性房颤患者左房功能,其定量参数可用于辅助预测血栓栓塞低风险患者发生血栓风险,应重点关注LAVmax和LAVImax增高及LAEF、LASr和LASr-c减低患者,并采取相应临床措施,以达到改善患者预后的目的。

Objective To investigate the effect of four-dimensional left atrial quantitative analysis technology on the evaluation of left atrial function in patients with non-valvular atrial fibrillation,and to analyze its predictive value on left atrial appendage thrombosis.Methods One hundred and eight patients with nonvalvular atrial fibrillation were selected as study subjects,all of whom were judged to be at low risk of thromboembolism after assessment by the atrial fibrillation stroke risk assessment system,and were divided into a thrombus group(n=12)and non-thrombus group(n=96)accord⁃ing to whether occurred thrombus or not.Left atrial volume parameters and left atrial strain were measured and compared between the two groups of patients,and logistic regression was used to analyze the factors affecting the occurrence of thrombus in the patients,and the predictive value of the left atrial volume parameters and strain parameters for the later occurrence of thrombus in patients at low risk of thromboembolism was examined by ROC.Results Compared with the non-thrombus group,the left atrial ejection fraction(LAEF),left atrial strain during reservoir phase(LASr),left atrial strain during conduit phase(LAScd),left atrial strain during contraction phase(LASct),left atrial strain during reservior phase-circumferential(LASr-c),left atrial strain during conduit phase-circumferential(LAScd-c)and left atrial strain during contraction phase-cir⁃cumferential(LASct-c)in the thrombus group de⁃creased,while the left atrial minimum volume(LAV⁃min),left atrial maximum volume(LAVmax),left atrial pre-systolic volume(LAVpreA),and left atrial maximum vol⁃ume index(LAVImax)increased(t=-4.80,-3.88,-3.62,-3.77,-3.58,-2.24,-2.07,3.68,3.88,3.38,3.82,P<0.05).Lo⁃gistic analysis showed that increased LAVmax and LAVImax and decreased LAEF,LASr,and LASr-c were all relevant factors that influencing the development of thrombus in patients at low risk for thromboembolism(OR=2.14,2.35,0.66,0.35,0.66,P<0.05).The AUC of combination detection of LAVmax,LAVImax,LAEF,LASr,and LASr-c was 0.97.Con⁃clusion Four-dimensional left atrial quantitative analysis technique can effectively assess left atrial function in patients with nonvalvular atrial fibrillation,and its quantitative parameters can be used to assist in predicting the risk of thrombo⁃sis in patients at low risk of thromboembolism.Focus should be placed on patients with increased LAVmax and LAVImax and decreased LAEF,LASr,and LASr-c,and corresponding clinical measures should be taken to achieve the goal of im⁃proving the prognosis of patients.