心房颤动患者左心耳形态及容积的年龄相关性研究
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摘要
目的探究心房颤动(房颤)患者左心耳形态、容积与年龄的关系及其影响因素。方法回顾性分析2015年1月至2018年6月于徐州医科大学附属医院行心脏增强CT的238例患者。将110例房颤患者纳入房颤组,128例窦性心律患者纳入窦律组。通过计算机断层扫描(CT)获得图像,行三维重建获取左心耳图像。观察比较两组患者的左心耳形态和左心耳矫正后容积(LAAVi),并分析与年龄的关系。结果房颤组LAAVi随着年龄的增大而增大(P<0.001),而窦律组LAAVi与年龄无关(P=0.379)。随着LAAVi增大,房颤组和窦律组中非鸡翅型左心耳分布均减少(P=0.004 vs. P=0.016)。房颤组非鸡翅左心耳分布随年龄增大而减少(P=0.003),而窦律组非鸡翅形左心耳分布与年龄无关(P=0.453),单因素及多因素Logistic回归分析示,年龄大于65岁(OR=0.485,P=0.005),房颤病程(OR=0.977,P=0.017)、LAAVi(OR=0.634,P<0.001)是房颤患者非鸡翅型左心耳的独立影响因素。结论随年龄的增大,房颤患者非鸡翅型左心耳倾向变低,当我们将非鸡翅型左心耳形态学作为房颤患者的卒中风险因素时,应注意年龄影响。
Objective To study the relationship between age and morphology and volume of left atrial appendage(LAA), and influence factors on them. Methods The patients(n=238) undergone enhanced computerized tomography(CT) were chosen from the Affiliated Hospital of Xuzhou Medical from Jan. 2015 to June 2018, and their data was retrospectively analyzed. All patients were divided into atrial fibrillation group(AF group, n=110) and sinus rhythm group(SR group, n=128). CT was used to obtain images and morphology of LAA and left atrial appendage volume index(LAAVi) were obtained by using reconstructed 3-dimensional images. The morphology LAA and LAAVi were compared between 2 groups, and the relationship between them and age was analyzed. Results LAAVi increased with aging in AF group(P<0.001), but was not related to age in SR group(P=0.379). As LAAVi, the distribution of non-chicken wing LAA(non-CW LAA) decreased in 2 groups(P=0.004 vs. P=0.016). The distribution of non-CW LAA decreased with aging in AF group(P=0.003), and was not related to age in SR group(P=0.453). The results of single-and multiple-factor Logistic regression analysis showed that age over 65(OR=0.485,P=0.005), AF course(OR=0.977,P=0.017) and LAAVi(OR=0.634, P<0.001) were independent influence factors of non-CW LAA in AF patients. Conclusion The prevalence of the non-CW LAA decreases with aging in patients with AF. When morphology of non-CW LAA is taken as a risk factor of stroke in AF patents, the effect of age should be paid attention to.
Objective To study the relationship between age and morphology and volume of left atrial appendage(LAA), and influence factors on them. Methods The patients(n=238) undergone enhanced computerized tomography(CT) were chosen from the Affiliated Hospital of Xuzhou Medical from Jan. 2015 to June 2018, and their data was retrospectively analyzed. All patients were divided into atrial fibrillation group(AF group, n=110) and sinus rhythm group(SR group, n=128). CT was used to obtain images and morphology of LAA and left atrial appendage volume index(LAAVi) were obtained by using reconstructed 3-dimensional images. The morphology LAA and LAAVi were compared between 2 groups, and the relationship between them and age was analyzed. Results LAAVi increased with aging in AF group(P<0.001), but was not related to age in SR group(P=0.379). As LAAVi, the distribution of non-chicken wing LAA(non-CW LAA) decreased in 2 groups(P=0.004 vs. P=0.016). The distribution of non-CW LAA decreased with aging in AF group(P=0.003), and was not related to age in SR group(P=0.453). The results of single-and multiple-factor Logistic regression analysis showed that age over 65(OR=0.485,P=0.005), AF course(OR=0.977,P=0.017) and LAAVi(OR=0.634, P<0.001) were independent influence factors of non-CW LAA in AF patients. Conclusion The prevalence of the non-CW LAA decreases with aging in patients with AF. When morphology of non-CW LAA is taken as a risk factor of stroke in AF patents, the effect of age should be paid attention to.
引文
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[14]Hoit BD,Shao Y,Tsai LM,et al. Altered left atrial compliance after atrial appendectomy. Influence on left atrial and ventricular filling[J].Circulation Research,1993,72(1):167-75.
[15]Veinot JP,Harrity PJ,Gentile F,et al. Anatomy of the Normal Left Atrial Appendage A Quantitative Study of Age-Related Changes in 500 Autopsy Hearts:Implications for Echocardiographic Examination[J]. Circulation,1997,96(9):3112.
[16]Kishima H,Mine T,Takahashi S,et al. Morphologic remodeling of left atrial appendage in patients with atrial fibrillation[J]. Heart rhythm,2016,13(9):1823-8.
[17]Wijffels M,Kirchhof C,Dorland R,et al. Atrial Fibrillation Begets Atrial Fibrillation[J]. Circulation,1995,92(7):1954-68.
[18]Shirani J,Alaeddini J. Structural remodeling of the left atrial appendage in patients with chronic non-valvular atrial fibrillation:Implications for thrombus formation, systemic embolism, and assessment by transesophageal echocardiography[J]. Cardiovascular Pathology,2000,9(2):95-101.
[19]Saito T,Tamura K,Uchida D,et al. Histopathological features of the resected left atrial appendage as predictors of recurrence after surgery for atrial fibrillation in valvular heart disease[J]. Circulation Journal,2007,71(1):70-8.
[2]Jeong WK,Choi JH,Son JP,et al. Volume and morphology of left atrial appendage as determinants of stroke subtype in patients with atrial fibrillation[J]. Heart rhythm,2016,13(4):820-7.
[3]Yaghi S,Song C,Gray WA,et al. Left Atrial Appendage Function and Stroke Risk[J]. Stroke,2015,46(12):3554-9.
[4]Lupercio F,Carlos J,Briceno DF,et al. Left atrial appendage morphology assessment for risk stratification of embolic stroke in patients with atrial fibrillation:A meta-analysis[J]. Heart rhythm,2016,13(7):1402-9.
[5]Di Biase L,Santangeli P,Anselmino M,et al. Does the left atrial appendage morphology correlate with the risk of stroke in patients with atrial fibrillation? Results from a multicenter study[J]. Journal of the American College of Cardiology,2012,60(6):531-8.
[6]Chen CH,Nakayama M,Nevo E,et al. Coupled systolic-ventricular and vascular stiffening with age:implications for pressure regulation and cardiac reserve in the elderly[J]. Journal of the American College of Cardiology,1998,32(5):1221.
[7]Yoshida K,Ulfarsson M,Oral H,et al. Left atrial pressure and dominant frequency of atrial fibrillation in humans[J]. Heart rhythm,2011,8(2):181-7.
[8]Bilchick KC,Mealor A,Gonzalez J,et al. Effectiveness of integrating delayed computed tomography angiography imaging for left atrial appendage thrombus exclusion into the care of patients undergoing ablation of atrial fibrillation[J]. Heart rhythm,2016,13(1):12-9.
[9]Lang RM,Bierig M,Devereux RB,et al. Recommendations for chamber quantification:a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology[J]. Journal of the American Society of Echocardiography:official publication of the American Society of Echocardiography,2005,18(12):1440-63.
[10]Wang Y,Di Biase L,Horton RP,et al. Left atrial appendage studied by computed tomography to help planning for appendage closure device placement[J]. Journal of cardiovascular electrophysiology,2010,21(9):973-82.
[11]Holmes DR, JR., Reddy VY. Left Atrial Appendage and Closure:Who, When, and How[J]. Circulation Cardiovascular interventions,2016,9(5):e002942.
[12]蒋超,张妍,李松南,等.左心耳封堵用于心房颤动患者脑卒中二级预防的有效性和安全性[J].中国医药,2018,13(1):1-4.
[13]Rich MW,Chyun DA,Skolnick AH,et al. Knowledge Gaps in Cardiovascular Care of the Older Adult Population:A Scientific Statement From the American Heart Association, American College of Cardiology, and American Geriatrics Society[J]. Journal of the American College of Cardiology,2016,67(20):2419-40.
[14]Hoit BD,Shao Y,Tsai LM,et al. Altered left atrial compliance after atrial appendectomy. Influence on left atrial and ventricular filling[J].Circulation Research,1993,72(1):167-75.
[15]Veinot JP,Harrity PJ,Gentile F,et al. Anatomy of the Normal Left Atrial Appendage A Quantitative Study of Age-Related Changes in 500 Autopsy Hearts:Implications for Echocardiographic Examination[J]. Circulation,1997,96(9):3112.
[16]Kishima H,Mine T,Takahashi S,et al. Morphologic remodeling of left atrial appendage in patients with atrial fibrillation[J]. Heart rhythm,2016,13(9):1823-8.
[17]Wijffels M,Kirchhof C,Dorland R,et al. Atrial Fibrillation Begets Atrial Fibrillation[J]. Circulation,1995,92(7):1954-68.
[18]Shirani J,Alaeddini J. Structural remodeling of the left atrial appendage in patients with chronic non-valvular atrial fibrillation:Implications for thrombus formation, systemic embolism, and assessment by transesophageal echocardiography[J]. Cardiovascular Pathology,2000,9(2):95-101.
[19]Saito T,Tamura K,Uchida D,et al. Histopathological features of the resected left atrial appendage as predictors of recurrence after surgery for atrial fibrillation in valvular heart disease[J]. Circulation Journal,2007,71(1):70-8.