经食管超声心动图对房颤合并左心耳血栓的诊断价值

Value of Transesophageal Echocardiography in the Diagnosis of Atrial Fibrillation Complicated with Left Auricular Thrombus

目的探讨经食管超声心动图(TEE)对房颤合并左心耳(LAA)血栓的诊断价值及对行LAA封堵术的指导意义。方法选取2019年4月至2023年4月郑州大学附属郑州中心医院收治的60例拟行LAA封堵术的房颤患者为研究对象,术前均检查LAA血栓、LAA开口等情况,排除存在手术禁忌证患者。比较合并LAA血栓患者与未合并LAA血栓患者LAA TEE参数,采用ROC分析TEE参数联合检测对房颤合并LAA血栓的诊断价值,术中采用TEE引导并测量LAA开口最小、最大直径及深度,术后3个月进行TEE复查。结果60例房颤患者经临床诊断合并LAA血栓32例,LAA开口过小2例(最大直径分别为15.92、16.43 mm),LAA开口过大1例(最大直径为32.19 mm),无手术禁忌证25例;合并LAA血栓患者LAA-min、LAA-max大于未合并LAA血栓患者(P<0.05);ROC分析结果显示,LAA-min、LAA-max联合诊断房颤合并LAA血栓的AUC为0.901,约登指数为0.799,最佳诊断敏感度为90.63%,最佳诊断特异度为89.29%。结论TEE对房颤合并LAA血栓有较高的诊断价值,并对LAA封堵术有较高的指导价值,临床应用价值较高,值得推广应用。

Objective To investigate the diagnostic value of transesophageal echocardiography(TEE)in atrial fibrillation associated with left atrial appendage(LAA)thrombosis and its guiding significance for LAA closure.Methods A total of 60 patients with atrial fibrillation who planned to undergo LAA occlusion in Zhengzhou Central Hospital Affiliated to Zhengzhou University from April 2019 to April 2023 were selected as the study objects.LAA thrombosis and LAA opening were examined before operation,and patients with surgical contraindications were excluded.The LAA TEE parameters of patients with LAA thrombosis were compared with those without LAA thrombosis,and the diagnostic value of TEE parameters combined with the detection of LAA thrombosis in atrial fibrillation was analyzed by ROC.The minimum,maximum diameter and depth of LAA opening were measured by TEE guidance during the operation,and TEE re-examination was performed 3 months after surgery.Results A total of 32 cases of 60 patients with atrial fibrillation were clinically diagnosed with LAA thrombosis,2 cases with small LAA opening(maximum diameter 15.92 and 16.43 mm,respectively),1 case with large LAA opening(maximum diameter 32.19 mm),and 25 cases with no contraindications.LAA-min and LAA-max in patients with LAA thrombosis were higher than those without LAA thrombosis(P<0.05).ROC analysis results showed that the AUC of LAA-min and LAA-max combined diagnosis of atrial fibrillation with LAA thrombosis was 0.901,the Jorden index was 0.799,the best diagnostic sensitivity was 90.63%,and the best diagnostic specificity was 89.29%.Conclusion TEE has high diagnostic value for atrial fibrillation complicated with LAA thrombus,and has high guiding value for LAA occlusion,and has high clinical application value,which is worthy of popularization and application.