中国医学装备2024，Vol.21Issue(7)：76-81,6.DOI:10.3969/j.issn.1672-8270.2024.07.013
经食管实时三维超声心动图、CT血管造影联合CHA2DS2-VASc评分对非瓣膜性房颤患者左心耳血栓形成的预测价值
Predictive value of the combination of RT-3D-TEE,CTA and CHA2DS2-VASc for left atrial appendage thrombosis in patients with non-valvular atrial fibrillation
摘要
Abstract
Objective:To investigate the predictive value of the combination of real-time three dimensional echocardiography of esophagus(RT-3D-TEE),computed tomography angiography(CTA)and congestive heart failure hypertension age diabetes mellitus prior stroke or transient ischemic attack vascular disease sex category(CHA2DS2-VASc)for left atrial appendage thrombosis in patients with non-valvular atrial fibrillation.Methods:A total of 88 patients with non-valvular atrial fibrillation admitted to the department of cardiovascular medicine of Cangzhou People's Hospital from January 2022 to June 2023 were selected as the study subjects.They were divided into thrombus group(n=36)and non-thrombus group(n=52)based on whether occurred left atrial appendage thrombosis.All patients underwent RT-3D-TEE and CTA examinations,and underwent CHA2DS2-VASc scoring.Logistic regression was used to analyze the related factors of forming left atrial appendage in patients with non-valvular atrial fibrillation.Receiver operating characteristic(ROC)curve was used to analyze the predictive values of RT-3D-TEE,CTA and CHA2DS2-VASc on left atrial appendage thrombosis in patients with non-valvular atrial fibrillation.And then,area under curve(AUC)value,sensitivity and specificity were calculated.Results:The maximum left atrial appendage emptying velocity(LAAeV)(51.48±5.87),the maximum left atrial appendage filling velocity(LAAfV)(48.36±5.49)and three-dimensional volume ejection fraction(3D-EF)(39.26±3.24)in the thrombus group were all significantly lower than those in the non-thrombus group,and the differences were statistically significant(t=5.933,6.767,4.605,P＜0.05),respectively.The opening diameter,short diameter and circumference,volume and area of left atrial appendage of the thrombus group were all larger than those of the non-thrombus group,while the ejection fraction was smaller than that of the non-thrombus group(t=6.581,3.410,9.220,3.178,4.453,4.162,P＜0.05),respectively.The ratios of cauliflower and cactus types of thrombus group were larger than those of non-thrombus group,and the ratios of wind vane type and chicken wing type were smaller than those of non-thrombus group,and the differences were significant(x2=3.771,7.132,1.003,5.455,P＜0.05),respectively.The CHA2DS2-VASc score of the thrombus group was significantly higher than that of the non-thrombus group,and the difference was statistically significant(t=12.269,P＜0.05).LAAeV,LAAfV,3D-EF,the long diameter of opening,the short diameter of opening,circumference of opening,volume,ejection fraction,spatial morphology and CHA2DS2 VASc score significantly correlated to the left atrial appendage thrombosis of patients with non-valvular atrial fibrillation(OR=4.323-19.562,P＜0.05).The sensitivity,specificity and AUC value of the combination of RT-3D-TEE,CTA and CHA2DS2-VASc were respectively 93.48%,90.83%and 0.895(0.654-0.963)in predicting left atrial appendage thrombosis of patients with non-valvular atrial fibrillation.Conclusion:The predictive values of RT-3D-TEE,CTA and CHA2DS2-VASc are higher for left atrial appendage thrombosis of patients with non-valvular atrial fibrillation.Among of them,the combinations of two or three indicators can effectively improve the predictive efficiency of individual test.The clinical practice should make choice on the basis of actual conditions.关键词
非瓣膜性房颤/左心耳血栓形成/经食管实时三维超声心动图/CT血管造影/预测价值Key words
Non-valvular atrial fibrillation/Left atrial appendage thrombosis/Real-time three dimensional echocardiography of esophagus(RT-3D-TEE)/Computed tomography angiography(CTA)/Predictive value分类
医药卫生引用本文复制引用
王钺,李晓冬,王睿,靳刚强,郝晓一..经食管实时三维超声心动图、CT血管造影联合CHA2DS2-VASc评分对非瓣膜性房颤患者左心耳血栓形成的预测价值[J].中国医学装备,2024,21(7):76-81,6.基金项目
河北省医学科学研究重点项目(20221208) Key Medical Science Research Projects in Hebei Province(20221208) （20221208）
