二维斑点追踪技术联合实时三维超声心动图对非瓣膜性心房颤动患者左心耳血栓形成的预测价值

The predictive value of two-dimensional speckle tracking technology combined with real-time threedimensional echocardiography for left atrial appendage thrombosis in patients with non-valvular atrial fibrillation

目的探讨二维斑点追踪技术(2D-STE)联合实时三维超声心动图(RT-3DE)参数预测非瓣膜性心房颤动(NVAF)患者左心耳血栓(LAAT)形成的价值。方法选取2023年1月至2023年8月于兰州大学第一医院经食管超声检出LAAT的NVAF患者20例为LAAT组,另选取未检出LAAT的NVAF患者52例作为非LAAT组,收集患者二维及三维超声心动图参数及基线资料,比较两组患者之间数据资料的差异;采用logistic回归分析NVAF患者LAAT的影响因素,利用Pearson相关性分析左心房球形度指数(LASI)与左心房容积指数(LAVI)之间的相关性,绘制受试者工作特征(ROC)曲线分析超声心动图参数对NVAF患者血栓的诊断效能。结果与非LAAT组相比,LAAT组患者N末端B型利钠肽原(NT-proBNP)水平升高[1437.50(650.50,2247.50)ng/ml比788.58(158.50,1242.50)ng/ml],差异具有统计学意义(P<0.05);LAAT组左心房前后径、上下径、左右径、LASI、左心房最大容积(LAV)、LAVI高于非LAAT组[(43.15±6.01)mm比(38.24±5.67)mm,(62.68±5.58)mm比(57.77±5.71)mm,(45.72±5.36)mm比(40.43±5.47)mm,(77.30±7.06)%比(69.71±6.24)%,(104.31±28.05)ml比(75.83±23.40)ml,(57.44±15.30)比(41.12±12.40)],左心室射血分数(LVEF)、左心房纵向应变峰值(PALS)低于非LAAT组[(54.16±6.30)%比(59.73±5.10)%,8.75(7.33,12.50)%比15.80(10.73,21.78)%],差异具有统计学意义(P<0.05)。Logistic回归分析显示,LAVI、LASI及PALS与NVAF患者LAAT独立相关。Pearson线性相关性分析显示LASI与LAVI之间正相关(r=0.399,P=0.001)。ROC曲线显示,LASI、LAVI、PALS预测LAAT的曲线下面积(AUC)分别为0.788(95%CI 0.666~0.911,P<0.01)、0.796(95%CI 0.684~0.908,P<0.01)、0.808(95%CI 0.698~0.919,P<0.01),最佳截断值分别为76.10%、53.92 ml/m^(2)、9.85%。联合预测LAAT时AUC为0.861(95%CI 0.761~0.960,P<0.05),特异度为85.0%,敏感度为75.0%。结论LAVI、LASI及PALS是NVAF患者LAAT的独立预测因子。2D-STE结合RT-3DE可以可作为一种经济、便捷、无创的工具,联合预测更有助于NVAF患者LAAT的检测。

Objective To explore the value of two-dimensional speckle tracking technology(2D-STE)combined with real-time three-dimensional echocardiography(RT-3DE)parameters in predicting left atrial appendage thrombosis(LAAT)formation in patients with non-valvular atrial fibrillation(NVAF).Method A total of 20 patients with LAAT detected by transesophageal echocardiography at the First Hospital of Lanzhou University from January 2023 to August 2023 were as LAAT group,and 52 patients without detected LAAT as the non LAAT group.The two-dimensional and three-dimensional echocardiography parameters and baseline data of the patients were collected,and the differences between the data of the two groups were compared.Logistic regression was used to analyze the influencing factors of LAAT in patients with NVAF,and Pearson linear correlation analysis was utilized to analyze the correlation between left atrial sphericity index(LASI)and left atrial volume index(LAVI);and receiver operating characteristic(ROC)curves was drawn to analyze the diagnostic efficacy of echocardiography parameters for thrombosis in NVAF patients.Result Compared with the control group,N-terminal B-type natriuretic peptide(NT-proBNP)levels were increased in the LAAT group[1437.50(650.50,2247.50)ng/ml vs.788.58(158.50,1242.50)ng/ml],and the difference was statistically significant(P<0.05).The left atrial anterior posterior diameter,upper and lower diameters,left and right diameters,LASI,maximum left atrial volume(LAV),and LAVI were increased in the LAAT group compared to the control group[(43.15±6.01)mm vs.(38.24±5.67)mm,(62.68±5.58)mm vs.(57.77±5.71)mm,(45.72±5.36)mm vs.(40.43±5.47)mm,(77.30±7.06)%vs.(69.71±6.24)%,(104.31±28.05)ml vs.(75.83±23.40)ml,(57.44±15.30)mm vs.(41.12±12.40)].The left ventricular ejection fraction(LVEF)and peak left atrial longitudinal strain(PALS)were decreased in the LAAT group compared to the control group[(54.16±6.30)%vs.(59.73±5.10)%,8.75(7.33,12.50)%vs.15.80(10.73,21.78)%],and the differences were statistically significant(P<0.05).Logistic regression analysis showed that LAVI,LASI,and PALS were independently correlated with LAAT in NVAF patients.Pearson linear correlation analysis showed a positive correlation between LASI and LAVI(r=0.399,P=0.001).The ROC curve showed that the area under the curve(AUC)for predicting LAAT by LASI,LAVI,and PALS were 0.788(95%CI 0.666-0.911,P<0.01),0.796(95%CI 0.684-0.908,P<0.01)and 0.808(95%CI 0.698-0.919,P<0.01)respectively.The optimal cutoff values were 76.10%and 53.92 ml/m²、9.85%.When combined predicting LAAT,the AUC was 0.861(95%CI 0.761-0.960,P<0.05),the specificity was 85.0%,and the sensitivity was 75.0%.Conclusion LAVI,LASI and PALS are the independent predictors of LAAT in patients with NVAF.2D-STE combined with RT-3DE can be used as an economical,convenient and non-invasive tool,which is more helpful for detecting LAAT in NVAF patients.