非瓣膜病心房颤动患者左心耳孔面积与机械功能关系的研究

Relationship between orifice area and mechanical function of left atrial appendage in patients with nonvalvular atrial fibrillation

目的探讨不同类型非瓣膜病心房颤动(房颤)患者左心耳孔面积与左心耳机械功能的关系。方法120例非瓣膜病房颤患者纳入本研究,其中阵发性房颤52例(43.3%),持续性房颤68例(56.7%)。通过计算机断层扫描血管造影(CTA)获得图像,行多平面重建获得左心耳孔面积。同时行经食道超声心动图检查测定左心耳流速(LAAFV),分析不同类型房颤患者左心耳孔面积与LAAFV的关系。结果在持续性房颤组中,较大左心耳孔面积与低LAAFV密切相关。多因素Logistic回归分析显示,左心耳孔面积(P=0.009,OR=2.169,95%CI:1.217~3.867)、左房内径(P<0.001,OR=1.514,95%CI:1.208~1.899)是低LAAFV的独立预测因子。在阵发性房颤组,左心耳孔面积同LAAFV无统计学相关。结论在不同类型非瓣膜病房颤患者中,左心耳孔面积对其机械功能的预测价值存在差异。在持续性房颤患者中,较大左心耳孔面积和较大左房内径是低左心耳流速的独立预测因子,而在阵发性房颤患者中,未发现此类相关性。

Objective To discuss the relationship between orifice area and mechanical function of left atrial appendage(LAA)in patients with non-valvular atrial fibrillation(NVAF).Methods NVAF patients(n=120)were chosen into the study,and among them there were 52 patients(43.3%)with paroxysmal atrial fibrillation(PAF group)and 68(56.7%)with persistent atrial fibrillation(PeAF group).The images were obtained by using computerized tomography angiography(CTA),and multiplanar reconstruction(MPR)was performed for getting LAA orifice area.Meanwhile LAA flow velocity(LAAFV)was detected by using transesophageal echocardiography(TEE).The relationship between LAA orifice area and LAAFV was analyzed in patients with different AF types.Results In PeAF group,larger LAA orifice area was closely correlated to lower LAAFV.The results of multi-factor Logistic regression analysis showed that LAA orifice area(P=0.009,OR=2.169,95%CI:1.217~3.867)and left atrial diameter(LAD,P<0.001,OR=1.514,95%CI:1.208~1.899)were independent predictive factors of lower LAAFV.In PAF group,there was no statistical correlation between LAA orifice area and LAAFV.Conclusion The predictive value of LAA orifice area to LAA mechanical function has difference in patients with different AF types.In PeAF patients,larger LAA orifice area and larger LAD are independent predictive factors of lower LAAFV,and in PAF patients this correlation was not observed.