摘要
目的探讨左心房-肺静脉CT增强结构特征对非瓣膜性心房颤动(NVAF)患者左心耳血栓形成的风险预测价值。方法回顾性收集2013年9月—2021年6月103例NVAF患者肺静脉CT增强检查和临床资料,根据经食管超声心动图(TEE)是否存在左心耳血栓,将患者分为血栓组53例与无血栓组50例。分析两组肺静脉CT增强结构特征,包括肺静脉开口直径、同侧上下肺静脉间夹角,左心房左右径、前后径及上下高径、左心耳的开口长径及深度,左心房中部CT值、左心耳开口处及最深部CT值及其相应的信噪比(SNR)及对比噪声比(CNR),并记录每位患者D-二聚体指标。采用t检验、单因素及多因素Logistic回归分析以上因素诊断左心耳血栓的价值。结果103例NVAF患者中,男62例,女41例,平均(67.17±5.32)岁。血栓组较无血栓组左侧肺静脉夹角较小(P=0.047),左心房各径线(左右径、上下径及前后径)(P=0.042、0.024、0.001)及左心耳开口长径较大(P<0.001);左心房中部SNR(P=0.003)、左心耳开口处及深部的CT值及SNR(P=0.053、0.006、0.01、0.044)、左心耳开口处CNR较小(P=0.009),差异均有统计学意义。两组年龄(P=0.747)、各肺静脉开口直径(P=0.464、0.284、0.702、0.159)、右侧上下肺静脉夹角(P=0.252)、左心耳深度(P=0.888)、左心房内CT值(P=0.156)均无显著差异(P>0.05)。D-二聚体有统计学差异(P=0.014)。多因素Logistic回归分析左心耳开口长径是NVAF患者左心耳血栓形成的独立危险因素(P=0.003)。ROC曲线分析当左心耳开口长径为22.5 mm时,诊断左心耳血栓的曲线下面积(AUC)为0.838,敏感度和特异度分别为77.2%、96.0%。结论NVAF患者左心耳开口长径增大、左心房各内径增大、左心耳开口处CT值降低、D-二聚体升高,对NVAF患者左心耳血栓形成均有一定的风险预测价值,D-二聚体的预测价值要低于其余各项,其中左心耳开口长径(22.5 mm)可作为独立风险量化指标。
Objective To explore the diagnostic value of left atrium-pulmonary vein CT characteristics for left atrial appendage thrombosis among patients with non-valvular atrial fibrillation(NVAF).Methods 103 NVAF patients[62 male,41 female;mean age:(67.17±5.32)years]between September 2013 and June 2021 were retrospectively divided into thrombosis and non-thrombosis groups by trans-esophageal echocardiography findings.Left atrium-pulmonary vein characteristics on contrast-enhanced CT including the diameter of the opening of each pulmonary vein,angle between the ipsilateral upper and lower pulmonary veins,left atrial width,length and depth,left atrial appendage opening length and depth,CT values of left atrial lumen,CT values and corresponding signal-to-noise ratios(SNR)and contrast-to-noise ratios(CNR)at the opening and deepest part of the left atrial appendage,and D-dimer index were compared using univariate and multivariate logistic regression analysis.Results Compared to the non-thrombosis group,patients in the thrombosis group had significantly smaller left pulmonary vein angle(P=0.047),larger left atrial width(P=0.042),length(P=0.024)and depth(P=0.001),longer left atrial appendage opening(P<0.001),higher SNR of the left atrial lumen(P=0.003),higher left atrial appendage opening and depth CT values(P=0.053,0.006)and SNR(P=0.01,0.044),and lower CNR of the left atrial appendage opening(P=0.009).There were no significant differences in age(P=0.747),pulmonary vein opening diameters(P=0.464,0.284,0.702,0.159),right upper and lower pulmonary vein angles(P=0.252),depth of left atrial appendage(P=0.888),and left atrial CT values(P=0.156).The D-dimer indexes were significantly different(P=0.014).Multivariate logistic regression analysis of left atrial appendage opening diameter was an independent risk factor for left atrial appendage thrombosis in patients with NVAF(P=0.003).Using the left atrial appendage opening length of 22.5 mm as cutoff value,the area under the receiver operating characteristic curve for diagnosing left atrial appendage thrombosis was 0.838 with 77.2% sensitivity and 96.0% specificity.Conclusion NVAF patients have longer left atrial appendage opening,larger left atrial lumen,lower CT values at the left atrial appendage opening,and elevated D-dimer.Left atrial appendage opening length of 22.5 mm can be used as an independent risk indicator whereas the predictive value of D-dimer is lower than the other variables.
作者
彭新华
吕传国
张珂
顾庆春
薛春华
PENG Xinhua;LYU Chuanguo;ZHANG Ke;GU Qingchun;XUE Chunhua(Department of Radiology,Qidong People’s Hospital(Affiliated Qidong Hospital of Nantong University),Jiangsu 226200,China)
出处
《影像诊断与介入放射学》
2023年第6期415-421,共7页
Diagnostic Imaging & Interventional Radiology
基金
江苏省南通市科技局指导性项目(MSZ20179)。
关键词
非瓣膜性心房颤动
血栓形成
左心耳
肺静脉CT增强
Non-valvular atrial fibrillation
Thrombosis
Left atrial appendage
Pulmonary vein CT angiography
