CT成像下左心耳形态和左心耳孔面积与缺血性卒中关系
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1.东南大学附属中大医院;2.盱眙市人民医院

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The relationship between left atrial appendage imaging obtained by CT and ischemic stroke
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ZHONG DA HOSPITAL SOUTHEAST UNIVERSITY

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    摘要:

    目的:本研究通过CT成像技术来探讨左心耳形态和左心耳孔面积与缺血性卒中的关系,希望提供一种无创且有效的关于缺血性卒中的危险因素。 方法:连续入选2020年4月至2021年4月期间东南大学附属中大医院接诊的60例缺血性卒中的非瓣膜性房颤患者(卒中组)。对照组包括60名年龄匹配的无卒中病史的非瓣膜性房颤患者。所有患者均接受了经胸超声心动图(Transthoracic echocardiography,TTE)、经食道超声心动图(Transesophageal echocardiography,TEE)和计算机断层扫描血管造影(Computed tomography angiography,CTA)检查。CTA检查完成后获得原始图像,并测量左心耳孔面积;使用GE公司的AW4.61工作站进行三维重建获得左心耳,根据左心耳形态将其分为鸡翅型和非鸡翅型,分析左心耳形态、左心耳孔面积与缺血性卒中的关系。 结果:临床资料中发现,卒中组较对照组患者中持续性房颤所占比例明显增加,卒中前CHA2DS2-VASc评分明显增高;与对照组(50.8±15.4, cm/s)比较,卒中组(32.0±12.4, cm/s)的LAAFV明显降低(P<0.001);与对照组比较,卒中组的非鸡翅型左心耳形态比例明显增加(P<0.001),左房内径和左心耳孔面积明显增大(P<0.001);而与对照组相比,卒中组的左心耳容积未发现统计学意义;将有统计学意义的变量纳入多元Logistic回归分析,结果显示,非鸡翅型左心耳形态、左心耳孔面积、左房内径、卒中前评分、LAAFV是缺血性卒中的独立预测因子。 结论:非瓣膜病房颤患者中,房颤类型、左心耳形态、左心耳孔面积、卒中前CHA2DS2-VASc评分、左房内径、LAAFV和缺血性卒中密切相关,非鸡翅型左心耳、较大的左心耳孔面积和左房内径是非瓣膜病房颤患者缺血性卒中的独立预测因子。 关键字 心房颤动;左心耳形态;左心耳孔面积;缺血性卒中

    Abstract:

    Objective To explore the relationship between the left atrial appendage morphology and the area of the left atrial appendage orifice and ischemic stroke via CT, hoping to provide a kind of non-invasive and effective risk factors for ischemic stroke. Methods Sixty non-valvular atrial fibrillation patients (stroke group) with ischemic stroke admitted to Southeast University Hospital from April 2020 to April 2021 were continuously selected. The control group included 60 age-matched patients with nonvalvular atrial fibrillation without a history of stroke. All patients underwent transthoracic echocardiography (TTE), transesophageal echocardiography (TEE) and computed tomography angiography (Computed tomography angiography, CTA) examinations. After the CTA inspection is completed, the original image is obtained and the area of the left atrial appendage orifice is measured; the left atrial appendage is obtained by three-dimensional reconstruction using GE's AW4.61 workstation. According to the left atrial appendage morphology, it is divided into chicken wing type and non-chicken wing type, and the left atrial appendage morphology, The relationship between the area of the left atrial appendage orifice and ischemic stroke. Results The clinical data found that the proportion of persistent atrial fibrillation in the stroke group was significantly higher than that in the control group, and the CHA2DS2-VASc score before stroke was significantly higher; compared with the control group (50.8±15.4, cm/s), the stroke group ( The LAAFV of 32.0±12.4, cm/s) was significantly reduced (P<0.001); compared with the control group, the proportion of non-chicken wing left atrial appendages in the stroke group was significantly increased (P<0.001), and the inner diameter of the left atrium and the area of the left atrial appendage were obvious Increase (P<0.001); compared with the control group, the left atrial appendage volume of the stroke group was not found to be statistically significant; the statistically significant variables were included in the multiple linear regression analysis, and the multiple linear regression analysis showed that the non-chicken wing type left atrial appendage Atrial appendage morphology, left atrial appendage foramen area, left atrial diameter, pre-stroke score, and LAAFV are independent predictors of ischemic stroke. Conclusion In patients with non-valvular atrial fibrillation, atrial fibrillation type, left atrial appendage morphology, left atrial appendage foramen area, pre-stroke CHA2DS2-VASc score, left atrial diameter, LAAFV and ischemic stroke are closely related, non-chicken wing type left atrial appendage, more large left atrial appendage foramen and left atrial diameter are independent predictors of ischemic stroke in patients with non-valvular atrial fibrillation. Key words atrial fibrillation; left atrial appendage morphology; left atrial appendage foramen area; ischemic stroke

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  • 收稿日期:2021-07-12
  • 最后修改日期:2021-09-28
  • 录用日期:2021-11-22
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