CTA在评估心房颤动患者术前左心耳形态功能变化及诊断血栓形成方面的价值

doi:10.3969/j.issn.1007-3205.2023.04.020

河北医科大学学报 ›› 2023, Vol. 44 ›› Issue (4): 472-477.doi: 10.3969/j.issn.1007-3205.2023.04.020

CTA在评估心房颤动患者术前左心耳形态功能变化及诊断血栓形成方面的价值

1.河北中石油中心医院影像科，河北廊坊 065000；2.河北省廊坊市人民医院耳鼻喉科，河北廊坊 065000

出版日期:2023-04-20 发布日期:2023-04-20
作者简介:徐建（1981-），男，河北廊坊人，河北中石油中心医院主管技师，医学学士，从事影像技术诊断研究。
基金资助:
廊坊市科学技术研究与发展计划项目（2021013040）

The value of CTA in evaluating the changes of left atrial appendage morphology and function and diagnosing thrombosis in patients with atrial fibrillation before operation

1.Department of Imaging, Hebei Petro China Central Hospital, Langfang 065000, China;
2.Department of Otorhinolarngology, Langfang People′s Hospital,
Hebei Province, Langfang 065000, China

Online:2023-04-20 Published:2023-04-20

摘要/Abstract

摘要： 目的探讨螺旋CT冠脉血管成像（spiral CT coronary angiography，CTA）评估心房颤动患者手术前左心耳形态功能参数及诊断血栓形成的价值。
方法选取河北中石油中心医院接受射频消融手术的患者98例为心房颤动组，另外选取自同期行CTA检查的窦性心率志愿者45例为对照组，对比2组研究对象的左心耳定量CTA参数、左心耳形态特征，以手术中所见结果诊断患者是否发生左心耳发生血栓，计算CTA诊断左心耳血栓的价值。
结果心房颤动组左心耳主叶长度、左心耳开口面积、左心耳口最长径、左心耳口最短径、左心耳容积、左心房容积测定值大于对照组（P＜0.05）；心房颤动组患者的左心耳排空速度、左心耳充盈速度测定值均小于对照组（P＜0.05）；心房颤动组左心耳呈菜花形的比例高于对照组（P＜0.05）；心房颤动组左心耳形态呈鸡翅形比例小于对照组（P＜0.05）。血栓形成组患者的左心耳主叶长度、左心耳口最长径、左心耳开口面积、左心耳容积测定值均大于无血栓组（P＜0.05）；血栓形成组左心耳排空速度、左心耳充盈速度测定值均小于无血栓组（P＜0.05）；血栓组左心耳呈菜花形的比例高于无血栓组（P＜0.05）；血栓组左心耳形态呈鸡翅形比例小于无血栓组（P＜0.05）；CTA诊断显示心房颤动患者左心耳血栓形成的敏感度为62.96%、特异度为92.96%、漏诊率为37.04%、误诊率为7.04%。
结论心房颤动患者的左心耳CTA参数及形态较窦性心律患者发生明显改变，同时CTA对于诊断心房颤动患者左心耳发生血栓具有较高的特异度，可作为临床辅助诊断的一种有效方式。

关键词: 心房颤动, 心耳, 冠脉血管成像

Abstract: Objective To explore the value of spiral CT coronary angiography (CTA) in evaluation of morphological and functional parameters of the left atrial appendage (LAA) and the diagnosis of thrombosis in patients with atrial fibrillation (AF) before operation.
Methods A total of 98 patients undergoing radiofrequency ablation in Hebei Petro China Central Hospital were selected as the AF group, and 45 volunteers with sinus rhythm who underwent CTA examination during the same period were selected as the control group. The quantitative CTA parameters and morphological characteristics of LAA in the two groups were compared, and whether the patients had LAA thrombosis was determined based on the results seen during the operation. The value of CTA in the diagnosis of LAA thrombosis was calculated.
Results The measured values of main lobe length of LAA, LAA opening area (LAAOA), the maximum diameter of LAA, the minimum diameter of LAA, LAA volume and left atrial volume in AF group were greater than those in control group (P＜0.05). The measured values of LAA emptying velocity (LAAEV) and LAA filling velocity (LAAFV) in patients with AF were lower than those in the control group (P＜0.05). The proportion of cauliflower-shaped LAA in the AF group was higher than that in the control group (P＜0.05), while the proportion of chicken wing-type LAA in AF group was smaller than that in control group (P＜0.05). The measured value of the length of the main lobe of LAA, the maximum diameter of LAA, LAAOA, and LAA volume in the thrombosis group were greater than those in the non-thrombosis group (P＜0.05), while the measured values of LAAEV and LAAFV in thrombosis group were lower than those in non-thrombosis group (P＜0.05). The proportion of cauliflower-shaped LAA in thrombosis group was higher than that in non-thrombosis group (P＜0.05), while the proportion of the chicken wing-type LAA in thrombosis group was smaller than that in non-thrombosis group (P＜0.05). CTA diagnosis showed that the sensitivity of LAA thrombosis in patients with AF was 62.96%, the specificity was 92.96%, and the missed diagnosis rate and misdiagnosis rate were 37.04% and 7.04% respectively.
Conclusion The CTA parameters and morphology of the LAA of patients with AF have significantly changed compared with those with sinus rhythm. In the meantime, CTA has a higher specificity for the diagnosis of thrombosis in the LAA of patients with AF, and can be used as an effective method for clinical auxiliary diagnosis.

Key words: atrial fibrillation, atrial appendage, coronary angiography

徐建, 王紫阳, 汪飞, 张新成, 韩克松, 李翠玲. CTA在评估心房颤动患者术前左心耳形态功能变化及诊断血栓形成方面的价值 [J]. 河北医科大学学报, 2023, 44(4): 472-477.

XU Jian, WANG Zi-yang, WANG Fei, ZHANG Xin-cheng, HAN Ke-song, LI Cui-ling. The value of CTA in evaluating the changes of left atrial appendage morphology and function and diagnosing thrombosis in patients with atrial fibrillation before operation[J]. Journal of Hebei Medical University, 2023, 44(4): 472-477.

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CTA在评估心房颤动患者术前左心耳形态功能变化及诊断血栓形成方面的价值

The value of CTA in evaluating the changes of left atrial appendage morphology and function and diagnosing thrombosis in patients with atrial fibrillation before operation

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