摘要
目的应用256层螺旋CT定量评估左心耳功能对房颤射频消融术后复发预测价值,为临床术前选择治疗方案提供依据。方法研究纳入63例首次进行射频消融术的房颤患者,平均年龄(59.43±10.67)岁,BMI:(25.99±3.60)kg/m2,男38例(60.3%),中位随访时间19个月(4~24个月),20例(31.7%)复发。根据房颤射频消融术后有无复发,分为复发组(n=20)和未复发组(n=43)。所有患者术前均行256层螺旋CT检查,将原始图像按心动周期从5%~95%,每间隔10%重建一个时相,测量并计算整个心动周期中左心耳最大容积(LAAVmax),左心耳最小容积(LAAVmin),左心耳排空分数(LAAEF),左心耳排血量(LAAEV),左心房最大容积(LAVmax),左心房最小容积(LAVmin),左心房排空分数(LAAEF),左心房排血量(LAAEV),将获得的数据运用统计学方法进行处理。结果对患者临床资料进行对比,除复发组CHA2DS2-VASc评分高于未复发组外(P<0.05),复发组与未复发组间年龄、性别、BMI、左心室射血分数(LVEF)、房颤持续时间及房颤类型均无明显统计学差异(P>0.05)。对左心耳及左心房功能分析,复发组LAAVmax、LAAVmin、LAVmax、LAVmin较未复发组增大(P<0.05),但复发组LAAEF、LAEF较未复发组减小(P<0.05)。多因素Cox比例风险回归分析显示LAAEF是房颤射频消融术后复发的独立预测因子(HR:0.790,95%CI:0.657~0.950,P=0.012)。ROC曲线分析显示,LAAEF<44.68%对射频消融术后复发预测价值最高(曲线下面积0.817),敏感性90%,特异性67.4%。结论心房颤动射频消融术后复发患者左心耳体积增大,功能减低。LAAEF是房颤射频消融术后复发的预测因子。
Objective 256-slice spiral CT was used to quantitatively evaluate the predictive value of left atrial appendage function for recurrence after catheter ablation of atrial fibrillation(AF),which provided a basis for clinical preoperative selection of treatment plan.Methods We analysed 63 patients(aged 59.43±10.67 years,BMI:25.99±3.60 kg/m2,60.3%male)with AF who underwent catheter ablation for the first time.The median follow-up time was 19(4-24)months.20 cases(31.7%)recurred.According to the recurrence of AF after catheter ablation,it was divided into recurrent group(n=20)and non-recurrence group(n=43).All patients underwent 256-slice spiral CT examination before operation.The original image was reconstructed from 5%-95%according to the cardiac cycle,and a phase was reconstructed at intervals of 10%.The maximum volume of left atrial appendage(LAAVmax),left atrial appendage minimum volume(LAAVmin),left atrial appendage emptying fraction(LAAEF),left atrial appendage ejection volume(LAAEV),left atrial maximum volume(LAVmax),left atrial minimum volume(LAVmin),left atrial emptying fraction(LAAEF)and left atrial ejection volume(LAAEV)were measured and analyzed statistically.Results The clinical data of the patients were compared.The CHA2DS2-VASc score in the recurrent group was higher than that in the non-recurrent group(P<0.05).For left atrial appendage and left atrial function analysis,LAAVmax,LAAVmin,LAVmax,and LAVmin were significantly higher in the recurrent group than in the non-recurrent group(P<0.05),but the LAAEF and LAEF in the recurrent group were lower than those in the non-recurrent group(P<0.05).Multivariate Cox proportional hazard regression analysis showed that LAAEF was an independent predictor of recurrence after catheter ablation of AF(HR:0.79095%CI:0.657-0.950 P=0.012).ROC curve analysis showed that LAAEF<44.68%had the highest predictive value for recurrence after catheter ablation(area under the curve was 0.817),sensitivity was 90%,and specificity was 67.4%.Conclusion Left atrial appendage volume increases and function decreases in patients with recurrence after catheter ablation of atrial fibrillation.LAAEF is a predictor of recurrence after catheter ablation of AF.
作者
袁迎芳
李彩英
田伟伟
卓立勇
陈琛
杨兰
YUAN Yingfang;LI Caiying;TIAN Weiwei(Department of Medical Imaging,the Second Hospital of Hebei Medical University,Shijiazhuang,Hebei Province 050000,P.R.China)
出处
《临床放射学杂志》
CSCD
北大核心
2020年第4期699-703,共5页
Journal of Clinical Radiology
关键词
心房颤动
左心耳功能
多层螺旋CT
射频消融术
Atrial fibrillation
Left atrial appendage function
MSCT
Catheter ablation
