256层螺旋CT观察左心耳形态结构在低CHA2DS2-VASc评分的房颤患者抗凝治疗中的应用

The application of 256-slice spiral CT in anticoagulation therapy by imaging left atrial appendage morphology in the patients with low CHA2DS2-VASc score atrial fibrillation

目的评估CHA2DS2-VASc评分≤1的非瓣膜性房颤(nonvalvular atrial fibrillation,NVAF患者中四种形态的左心耳所对应的脑卒中/TIA风险,然后观察抗凝治疗对菜花型左心耳患者的预防效果。方法通过Philips 256层螺旋CT结合3D立体渲染技术获得160例NVAF患者的左心耳结构数据,根据左心耳形态分为'仙人掌'组、'风向标'组、'鸡翅'组和'菜花'组,随访一年并统计脑卒中/TIA事件。接着将其中'菜花'组的患者分为华法林抗凝实验组和未抗凝的对照组,随访一年并统计脑卒中/TIA事件。结果菜花型左心耳AF患者的脑卒中/TIA发病率最高(30.0%),抗凝治疗后发病率明显降低(5.0%vs. 35.0%,P=0.018)。结论菜花型左心耳所对应的低CHA2DS2-VASc评分NVAF患者发生脑卒中/TIA事件的概率较高,但经华法林抗凝治疗后得到了明显控制,研究结果在房颤的治疗上具有指导意义。

Objective To assess the risk of stroke/TIA by imaging 4 kinds of left atrial appendage(LAA)in patients with nonvalvular atrial fibrillation(NVAF)and low CHA2 DS2-VASc scores,then we observed the effect of anticoagulation therapy in patients with cauliflower-like LAA.Methods The LAA characteristics of160 patients were obtained by 256-slice spiral CT(Philips)and 3 D volume rendering.Then we divided them into four groups by morphology(Cactus,Windsock,Chicken-Wing,and Cauliflower)and follow-up for one year and statistically compared stroke/TIA events.Afterwards,we divided the patients in cauliflower group into two groups,anticoagulant therapy group and the control group,then compared the number of the patients with stroke/TIA events in the following year.Results The morbidity of stroke/TIA was highest in NVAF patients with cauliflower-like LAA(30.0%).However,after a year of anticoagulant therapy,it was reduced significantly(5.0%vs.35.0%,P=0.018).Conclusions The morbidity of stroke/TIA was high in NVAF patients with low CHA2 DS2-VASc scores and cauliflower-like LAA,but it was reduced after anticoagulant therapy.These may have significance in the treatment of NVAF.