多层螺旋CT与超声心动图诊断房颤患者左心耳血栓的临床价值比较
|
摘要
目的分析多层螺旋CT(MSCT)与经食管超声心动图(TEE)两种影像学检查方法对房颤患者左心耳血栓的诊断价值。方法遴选近一年(2017年1月-2018年1月)来我院诊治的房颤患者195例,在拟行导管消融治疗前均行冠状动脉CT血管造影(CTA)及实时三维经食管超声心动图(RT-3D-TEE)检查,以RT-3D-TEE检查结果为"金标准",分析评估CTA检查的诊断效能,并比较两种检查结果的一致性。结果RT-3DTEE检查诊断左心耳血栓阳性患者14例,左心耳血栓阴性患者181例,以RT-3DTEE检查结果为参考标准,冠脉CTA检查诊断房颤患者左心耳血栓的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为78.57%、96.69%、95.38%、64.71%、98.31%;两种检查方法对房颤患者左心耳血栓的诊断结果具有较高的一致性(kappa值=68.79%,P<0.01)。结论多层螺旋CT技术对房颤患者左心耳血栓的诊断效能较高,且与超声心动图检测结果一致性佳。
Objective To analyze the diagnostic value of two imaging examinations of multi-slice spiral CT(MSCT) and transesophageal echocardiography(TEE) for left atrial appendage thrombosis in patients with atrial fibrillation. Methods 195 cases of patients with atrial fibrillation who were diagnosed and treated in our hospital during the past year(January 2017 to January 2018) were selected. evaluated by computed tomographic angiography(CTA) and real-time three-dimensional transesophageal echocardiography(RT-3 D-TEE) before catheter ablation treatment. The RT-3 D-TEE test results were used as "gold standard", and the diagnostic efficacy of CTA was evaluated and compared,and the consistency of the two methods was analyzed. Results 14 cases of patients with positive left atrial appendage thrombus and 181 patients with negative left atrial appendage thrombus by RT-3 D TEE examination. Taken RT-3 D TEE test results as reference, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of coronary CTA examination in the diagnosis of left atrial appendage thrombosis in patients with atrial fibrillation were 78.57%, 96.69%, 95.38%, 64.71% and 98.31% respectively.The two examination methods had high consistency in the diagnosis of left atrial appendage thrombosis in patients with atrial fibrillation(kappa value=68.79%, P<0.01).Conclusion Multi-slice spiral CT has high diagnostic efficacy in the diagnosis of left atrial appendage thrombosis in patients with atrial fibrillation, and it has good consistency with the results of echocardiography.
Objective To analyze the diagnostic value of two imaging examinations of multi-slice spiral CT(MSCT) and transesophageal echocardiography(TEE) for left atrial appendage thrombosis in patients with atrial fibrillation. Methods 195 cases of patients with atrial fibrillation who were diagnosed and treated in our hospital during the past year(January 2017 to January 2018) were selected. evaluated by computed tomographic angiography(CTA) and real-time three-dimensional transesophageal echocardiography(RT-3 D-TEE) before catheter ablation treatment. The RT-3 D-TEE test results were used as "gold standard", and the diagnostic efficacy of CTA was evaluated and compared,and the consistency of the two methods was analyzed. Results 14 cases of patients with positive left atrial appendage thrombus and 181 patients with negative left atrial appendage thrombus by RT-3 D TEE examination. Taken RT-3 D TEE test results as reference, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of coronary CTA examination in the diagnosis of left atrial appendage thrombosis in patients with atrial fibrillation were 78.57%, 96.69%, 95.38%, 64.71% and 98.31% respectively.The two examination methods had high consistency in the diagnosis of left atrial appendage thrombosis in patients with atrial fibrillation(kappa value=68.79%, P<0.01).Conclusion Multi-slice spiral CT has high diagnostic efficacy in the diagnosis of left atrial appendage thrombosis in patients with atrial fibrillation, and it has good consistency with the results of echocardiography.
引文
[1]蒋捷.心房颤动患者长期管理—房颤中心的临床实践[J].中国介入心脏病学杂志,2016,24(3):179-180.
[2]贺钦,许广莉,陈妍君,等.心房颤动治疗对认知功能影响的研究进展[J].中国循环杂志,2017, 32(3):301-303.
[3]陈继美,张萍.超声心动图预测心房颤动患者左心房血栓形成[J].中国介入影像与治疗学,2017, 14(2):113-117.
[4]吴丹丹,陈瑜,张腾.房颤发病机制研究新进展[J].中西医结合心脑血管病杂志,2016, 14(12):1342-1346.
[5]陈爱华,宋旭东,杨平珍.房颤射频消融治疗的现状与困境[J].解放军医学杂志,2015, 40(2):85-91.
[6]李虹,李一丹,魏丽群,等.经食管超声心动图与双源C T诊断心房颤动患者左心耳血栓及相关临床资料分析[J].中国医学影像技术,2016, 32(12):1871-1875.
[7]杜先锋,储慧民,何斌,等.心房颤动合并血栓栓塞事件患者的左心耳流速及收缩功能分析[J].心脑血管病防治,2015, 15(2):129-1 30.
[8]郑桂安,林春艺,翁兰,等.左心耳体积对心房颤动导管射频消融术后复发的预测价值[J].中华心血管病杂志,2017, 45(11):924-929.
[9]孙兰兰,吕秀章,李一丹,等.实时三维经食管超声心动图定量心房颤动患者左心耳口大小的临床研究[J].中国超声医学杂志,2016, 32(11):990-993.
[10]张丽丽,石琳,祝安慧,等. 64排螺旋CT与经食道超声对房颤患者左房血栓的检测[J].中国心血管杂志,2016, 21(1):42-45.
[2]贺钦,许广莉,陈妍君,等.心房颤动治疗对认知功能影响的研究进展[J].中国循环杂志,2017, 32(3):301-303.
[3]陈继美,张萍.超声心动图预测心房颤动患者左心房血栓形成[J].中国介入影像与治疗学,2017, 14(2):113-117.
[4]吴丹丹,陈瑜,张腾.房颤发病机制研究新进展[J].中西医结合心脑血管病杂志,2016, 14(12):1342-1346.
[5]陈爱华,宋旭东,杨平珍.房颤射频消融治疗的现状与困境[J].解放军医学杂志,2015, 40(2):85-91.
[6]李虹,李一丹,魏丽群,等.经食管超声心动图与双源C T诊断心房颤动患者左心耳血栓及相关临床资料分析[J].中国医学影像技术,2016, 32(12):1871-1875.
[7]杜先锋,储慧民,何斌,等.心房颤动合并血栓栓塞事件患者的左心耳流速及收缩功能分析[J].心脑血管病防治,2015, 15(2):129-1 30.
[8]郑桂安,林春艺,翁兰,等.左心耳体积对心房颤动导管射频消融术后复发的预测价值[J].中华心血管病杂志,2017, 45(11):924-929.
[9]孙兰兰,吕秀章,李一丹,等.实时三维经食管超声心动图定量心房颤动患者左心耳口大小的临床研究[J].中国超声医学杂志,2016, 32(11):990-993.
[10]张丽丽,石琳,祝安慧,等. 64排螺旋CT与经食道超声对房颤患者左房血栓的检测[J].中国心血管杂志,2016, 21(1):42-45.