For patients with atrial fibrillation with an increased risk of stroke and contraindications to long-term anticoagulation,percutaneous left atrial appendage closure(LAAC)has become an important alternative to long-ter...For patients with atrial fibrillation with an increased risk of stroke and contraindications to long-term anticoagulation,percutaneous left atrial appendage closure(LAAC)has become an important alternative to long-term oral anticoagulation.Incomplete closure of the LAAC during the procedure leads to faster blood flow in the interstitial space around the device,resulting in peri-device leak(PDL),which is not uncommon.Studies are still inconclusive in determining the incidence,long-term safety,and management of PDL.Therefore,this article reviewed the progress made in the research and treatment of PDL after LAAC.展开更多
Objective:To explore the diagnosis value of a low dose,dual-energy cardiac computed tomography angiography(CTA)with non-electrocardiography-gated(non-ECG-gated)in detecting left atrial appendage(IAA)thrombus.Methods:C...Objective:To explore the diagnosis value of a low dose,dual-energy cardiac computed tomography angiography(CTA)with non-electrocardiography-gated(non-ECG-gated)in detecting left atrial appendage(IAA)thrombus.Methods:Consecutive patients with atrial fibrillation who underwent cardiac CTA protocol(dual-energy scan for arterial phase and conventional scan for delayed phase)were prospectively enrolled.LAA lesions were proved by clinical comprehensive diagnosis,the final study included 18 cases with LAA thrombus and 48 cases with circulatory stasis.Quantitative parameters derived from dual-energy images were measured for the LAA lesions,including the conventional CT attenuation value(CT value),iodine concentration(IC),normalized iodine concentration(NIC),effective atomic number values(Zeff)and energy spectrum curve slope(Slope).The differences between LAA thrombus group and circulatory stasis group were compared by independent sample t-test or Wilcoxon rank sum test regarding to the normality test.The diagnosis performance of the dual-energy parameters was assessed using receiver operating characteristic(ROC)curve analysis and area under curve(AUC).Results:All the dual-energy parameters were demonstrated significantly difference between LAA thrombus and circulatory stasis group(P<0.05),and showed better diagnostic performance than the conventional CT value.ROC analysis revealed IC was the most predictive parameter with AUC equal to 0.836.The radiation dose in the arterial phase was(2.640.66)mSv.Conclusion:Dual-energy CTA scanning shows convincing diagnostic performance in detecting left atrial appendage thrombus with lower radiation dose,and may help reduce the need for delayed phase scan.展开更多
基金Supported by Zhejiang Provincial Foundation for Medical and Health Sciences,No.2021KY980.
文摘For patients with atrial fibrillation with an increased risk of stroke and contraindications to long-term anticoagulation,percutaneous left atrial appendage closure(LAAC)has become an important alternative to long-term oral anticoagulation.Incomplete closure of the LAAC during the procedure leads to faster blood flow in the interstitial space around the device,resulting in peri-device leak(PDL),which is not uncommon.Studies are still inconclusive in determining the incidence,long-term safety,and management of PDL.Therefore,this article reviewed the progress made in the research and treatment of PDL after LAAC.
基金the Scientific Research Fund of Joint Construction Project of Henan Province and Ministry of Medical Science and Technology(No.SB201901097)ChinaHenan Provincial Key Laboratory of Cardiology Medical Imaging(No.2021-44-16),China.
文摘Objective:To explore the diagnosis value of a low dose,dual-energy cardiac computed tomography angiography(CTA)with non-electrocardiography-gated(non-ECG-gated)in detecting left atrial appendage(IAA)thrombus.Methods:Consecutive patients with atrial fibrillation who underwent cardiac CTA protocol(dual-energy scan for arterial phase and conventional scan for delayed phase)were prospectively enrolled.LAA lesions were proved by clinical comprehensive diagnosis,the final study included 18 cases with LAA thrombus and 48 cases with circulatory stasis.Quantitative parameters derived from dual-energy images were measured for the LAA lesions,including the conventional CT attenuation value(CT value),iodine concentration(IC),normalized iodine concentration(NIC),effective atomic number values(Zeff)and energy spectrum curve slope(Slope).The differences between LAA thrombus group and circulatory stasis group were compared by independent sample t-test or Wilcoxon rank sum test regarding to the normality test.The diagnosis performance of the dual-energy parameters was assessed using receiver operating characteristic(ROC)curve analysis and area under curve(AUC).Results:All the dual-energy parameters were demonstrated significantly difference between LAA thrombus and circulatory stasis group(P<0.05),and showed better diagnostic performance than the conventional CT value.ROC analysis revealed IC was the most predictive parameter with AUC equal to 0.836.The radiation dose in the arterial phase was(2.640.66)mSv.Conclusion:Dual-energy CTA scanning shows convincing diagnostic performance in detecting left atrial appendage thrombus with lower radiation dose,and may help reduce the need for delayed phase scan.