心脏CT左房参数在预测房颤患者卒中发生中的价值
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摘要
目的:应用心脏CT评估房颤患者左心房、左心耳结构以及功能状况,探讨其与房颤患者卒中发生的关系。方法:回顾性分析221例房颤患者心脏CT资料,根据病程中患者有无发生卒中分成卒中组和非卒中组。以图像后处理软件测量左心房和左心耳最大、最小容积,计算左心房及心耳的射血分数。根据心耳形态将其分成鸡翅型和非鸡翅型,并观察心耳内是否存在血栓或血栓前状态。对左房各项参数进行单因素及多因素统计学分析。结果:221例中47例发生了卒中事件。卒中组患者的左心房最大容积、最小容积均较非卒中组增大(P <0.05),卒中组左心房射血分数较非卒中组下降(P <0.05)。卒中组左心耳非鸡翅型的比例更高(P=0.006);卒中组左房内存在血栓或血栓前状态的比例高于非卒中组(P=0.01)。左心房容积、左心耳分叶结构及左心耳血流动力学状态是房颤患者卒中发生的独立危险因素。结论:心脏CT获得的左房参数对房颤患者卒中发生具有一定预测价值。
Objective:To assess the structure and function remodeling of left atrial(LA)and left atrial appendage(LAA)using cardiac CT in patients with atrial fibrillation(AF),and to evaluate its relation with stroke. Methods:We retrospectively analyzed the CT imaging of 221 patients with AF and divided them into the stroke group and the non-stroke group. The left atrium maximum volume(LAVmax),left artium minimum volume(LAVmin),left artrium appendage maximum volume(LAAVmax)and left artrium appendage minimum volume(LAAVmin)were segmented and measured by post-processing software. The LA and LAA ejection fractions(LAEF,LAAEF)and LAA were calculated. According to the shape of the appendage,we divided LAA into chicken wings and non-chicken wings. And whether there was a thrombus or circulatroy stasis in LAA was also observed. Univariate and multivariate statistical analyses were carried out on the parameters of LA. Results:Among the 221 patients with AF,47 patients developed a stroke. The LAVmaxand LAVminin the stroke group were significantly larger than those in the non-stroke group(P < 0.05),LAEF in the stroke group decreased compared with the non-stroke group(P < 0.05). The proportion of non-chicken wing type in the stroke group was higher than that in the non-stroke group(P=0.006). The proportion of thrombosis or pre-thrombotic state in the LA of the stroke group was higher than that in the non-stroke group(P=0.01). The LA volume,LAA structure,and LAA hemodynamic status were independently associated with stroke. Conclusion:LA parameters measured by cardiac CT may be useful for predicting stroke in patients with AF.
Objective:To assess the structure and function remodeling of left atrial(LA)and left atrial appendage(LAA)using cardiac CT in patients with atrial fibrillation(AF),and to evaluate its relation with stroke. Methods:We retrospectively analyzed the CT imaging of 221 patients with AF and divided them into the stroke group and the non-stroke group. The left atrium maximum volume(LAVmax),left artium minimum volume(LAVmin),left artrium appendage maximum volume(LAAVmax)and left artrium appendage minimum volume(LAAVmin)were segmented and measured by post-processing software. The LA and LAA ejection fractions(LAEF,LAAEF)and LAA were calculated. According to the shape of the appendage,we divided LAA into chicken wings and non-chicken wings. And whether there was a thrombus or circulatroy stasis in LAA was also observed. Univariate and multivariate statistical analyses were carried out on the parameters of LA. Results:Among the 221 patients with AF,47 patients developed a stroke. The LAVmaxand LAVminin the stroke group were significantly larger than those in the non-stroke group(P < 0.05),LAEF in the stroke group decreased compared with the non-stroke group(P < 0.05). The proportion of non-chicken wing type in the stroke group was higher than that in the non-stroke group(P=0.006). The proportion of thrombosis or pre-thrombotic state in the LA of the stroke group was higher than that in the non-stroke group(P=0.01). The LA volume,LAA structure,and LAA hemodynamic status were independently associated with stroke. Conclusion:LA parameters measured by cardiac CT may be useful for predicting stroke in patients with AF.
引文
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[4] Szymanski FM,Lip GY,Filipiak KJ,et al. Stroke risk fac-tors beyond the CHA2DS2-VASc score:Can we improveour identification of“high stroke risk”patients with atrialfibrillation?[J]. Am J Cardiol,2015,116(11):1781-1788
[5] Park MJ,Jung JI,Oh YS,et al. Assessment of the structur-al remodeling of the left atrium by 64-multislice cardiacCT:comparative studies in controls and patients with atri-al fibrillation[J]. Int J Cardiol,2012,159(3):181-186
[6] Hur J,Choi BW. Cardiac CT imaging for ischemic stroke:Current and evolving clinical applications[J]. Radiology,2017,283(1):14-28
[7] Di Biase L,Santangeli P,Anselmino M,et al. Does theleft atrial appendage morphology correlate with the risk ofstroke in patients with atrial fibrillation? Results from amulticenter study[J]. J Am Coll Cardiol,2012,60(6):531-538
[8] Kamel H,Okin PM,Elkind MS,et al. Atrial fibrillationand mechanisms of stroke:Time for a new model[J].Stroke,2016,47(3):895-900
[9]木胡牙提,卢武红,马依彤,等. 1 041例非瓣膜性心房颤动患者左心房内径的分析[J].中国循环杂志,2009,24(5):364-366
[10] Barnes ME,Miyasaka Y,Seward JB,et al. Left atrial vol-ume in the prediction of first ischemic stroke in an elderlycohort without atrial fibrillation[J]. Mayo Clin Proc,2004,79(8):1008-1014
[11] Dawn B,Varma J,Singh P,et al. Cardiovascular death inpatients with atrial fibrillation is better predicted by leftatrial thrombus and spontaneous echocardiographic con-trast as compared with clinical parameters[J]. J Am SocEchocardiogr,2005,18(3):199-205
[12] Bernhardt P,Schmidt H,Hammerstingl C,et al. Patientswith atrial fibrillation and dense spontaneous echo contrast at high risk a prospective and serial follow-up over12 months with transesophageal echocardiography and cerebral magnetic resonance imaging[J]. J Am Coll Cardiol,2005,45(11):1807-1812
[13] Boucebci S,Pambrun T,Velasco S,et al. Assessment of normal left atrial appendage anatomy and function over gender and ages by dynamiccardiac CT[J]. Eur Radiol,2016,26(5):1512-1520
[14]Leung DY,Black IW,Cranney GB,et al. Prognostic implications of left atrial spontaneous echo contrast in nonvalvular atrial fibrillation[J]. J Am Coll Cardiol,1994,24(3):755-762
[15] Somerville W,Chambers RJ. Systemic embolism in mitral stenosis:relation to the size of the left atrial appendix[J].Br Med J,1964,2(5418):1167-1169
[16]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):3112-3115
[2] Wolf PA,Abbott RD,Kannel WB. Atrial fibrillation:a ma-jor contributor to stroke in the elderly:the FraminghamStudy[J]. Arch Intern Med,1987,147(9):1561-1564
[3] Delgado V,Di Biase L,Leung M,et al. Structure and func-tion of the left atrium and left atrial appendage:AF andstroke implications[J]. J Am Coll Cardiol,2017,70(25):3157-3172
[4] Szymanski FM,Lip GY,Filipiak KJ,et al. Stroke risk fac-tors beyond the CHA2DS2-VASc score:Can we improveour identification of“high stroke risk”patients with atrialfibrillation?[J]. Am J Cardiol,2015,116(11):1781-1788
[5] Park MJ,Jung JI,Oh YS,et al. Assessment of the structur-al remodeling of the left atrium by 64-multislice cardiacCT:comparative studies in controls and patients with atri-al fibrillation[J]. Int J Cardiol,2012,159(3):181-186
[6] Hur J,Choi BW. Cardiac CT imaging for ischemic stroke:Current and evolving clinical applications[J]. Radiology,2017,283(1):14-28
[7] Di Biase L,Santangeli P,Anselmino M,et al. Does theleft atrial appendage morphology correlate with the risk ofstroke in patients with atrial fibrillation? Results from amulticenter study[J]. J Am Coll Cardiol,2012,60(6):531-538
[8] Kamel H,Okin PM,Elkind MS,et al. Atrial fibrillationand mechanisms of stroke:Time for a new model[J].Stroke,2016,47(3):895-900
[9]木胡牙提,卢武红,马依彤,等. 1 041例非瓣膜性心房颤动患者左心房内径的分析[J].中国循环杂志,2009,24(5):364-366
[10] Barnes ME,Miyasaka Y,Seward JB,et al. Left atrial vol-ume in the prediction of first ischemic stroke in an elderlycohort without atrial fibrillation[J]. Mayo Clin Proc,2004,79(8):1008-1014
[11] Dawn B,Varma J,Singh P,et al. Cardiovascular death inpatients with atrial fibrillation is better predicted by leftatrial thrombus and spontaneous echocardiographic con-trast as compared with clinical parameters[J]. J Am SocEchocardiogr,2005,18(3):199-205
[12] Bernhardt P,Schmidt H,Hammerstingl C,et al. Patientswith atrial fibrillation and dense spontaneous echo contrast at high risk a prospective and serial follow-up over12 months with transesophageal echocardiography and cerebral magnetic resonance imaging[J]. J Am Coll Cardiol,2005,45(11):1807-1812
[13] Boucebci S,Pambrun T,Velasco S,et al. Assessment of normal left atrial appendage anatomy and function over gender and ages by dynamiccardiac CT[J]. Eur Radiol,2016,26(5):1512-1520
[14]Leung DY,Black IW,Cranney GB,et al. Prognostic implications of left atrial spontaneous echo contrast in nonvalvular atrial fibrillation[J]. J Am Coll Cardiol,1994,24(3):755-762
[15] Somerville W,Chambers RJ. Systemic embolism in mitral stenosis:relation to the size of the left atrial appendix[J].Br Med J,1964,2(5418):1167-1169
[16]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):3112-3115