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目的通过心脏增强断层扫描(CT)分析非瓣膜性心房颤动(NVAF)患者左心耳(LAA)大小及形态,并探讨CT在NVAF患者血栓栓塞预防诊疗中的价值。方法前瞻性的纳入2012年12月至2014年1月拟行射频消融术治疗的NVAF患者189例,同时纳入无并发器官功能障碍的相对正常的拟行射频消融术的房性心动过速(简称房速)患者作为对照组(52例),术前行CT心脏增强扫描检查。对纳入患者进行包括基本资料、并发疾病、抗凝治疗和心房颤动(AF)持续情况在内的全面的临床评估。采用CHA2DS2-VASc评分标准评价NVAF患者血栓栓塞风险。并根据CT显像LAA有无血栓形成将NVAF患者分为血栓组(13例)和非血栓组(176例)。比较对照组和不同CHA2DS2-VASc评分血栓栓塞风险亚组以及有无LAA血栓形成亚组之间LAA大小、形态的差异,并通过logistic回归模型分析上述LAA参数对NVAF患者血栓形成风险的预测价值。结果与对照组比较,NVAF患者具有较大的LAA开口径,对照组风向标及仙人掌型LAA居多,而NVAF患者4种LAA形态大致相等。LAA开口及容积随着CHA2DS2-VASc评分血栓栓塞风险的增加而呈增大趋势,中低危血栓栓塞风险组鸡中翼型LAA居多,而栓塞高风险组菜花型LAA居多。与非血栓组比较,LAA血栓组NVAF患者具有较大的LAA开口、容积和较多的菜花型LAA。Logistic回归分析提示除CHA2DS2-VASc评分外,菜花型及大的LAA开口径可独立预测NVAF患者的血栓形成风险。结论心脏CT增强扫描能很好地分析LAA大小及形态,且相关参数对NVAF患者LAA血栓形成有一定的预测价值。
Objective To investigate the size and shape of left atrial appendage (LAA) in patients with non-valvular atrial fibrillation (NVAF) by cardiac enhanced tomography (CT) and to explore the value of CT in the prevention and treatment of thromboembolism in patients with NVAF. Methods A total of 189 patients with NVAF scheduled for radiofrequency ablation from December 2012 to January 2014 were prospectively enrolled. Atrial fibrillation was performed in patients with NVAF undergoing relatively normal organ dysfunction Atrial tachycardia) patients as control group (52 cases), preoperative CT cardiac enhanced scan. Patients enrolled in a comprehensive clinical assessment that included basic information on concurrent disease, anticoagulant therapy and atrial fibrillation (AF). The CHA2DS2-VASc score was used to assess the risk of thromboembolism in patients with NVAF. NVAF patients were divided into thrombus group (n = 13) and non-thrombus group (n = 176) according to CT angiography of LAA. The differences in LAA size and morphology between the subgroup of thromboembolism and CHA2DS2-VASc risk subgroups were compared. The predictive value of LAA parameters in predicting thrombosis risk was analyzed by logistic regression model. Results Compared with the control group, NVAF patients had larger LAA opening diameter, the control group had the most vane and cactus LAA, while the four LAA forms in NVAF patients were almost the same. The opening and volume of LAA tended to increase with the increasing risk of thromboembolism in the CHA2DS2-VASc group. Most of the LAA in the mid-low risk thromboembolism risk group was in the chicken, while LAA in the high-risk group was the highest. Compared with non-thrombus group, LAA thrombus group had larger LAA opening, volume and more cauliflower LAA. Logistic regression analysis showed that cauliflower type and large LAA opening diameter independently predicted the risk of thrombosis in patients with NVAF except CHA2DS2-VASc score. Conclusions The enhanced cardiac CT scan can well analyze the size and shape of LAA, and the related parameters have certain predictive value for LAA thrombosis in patients with NVAF.