心脏CT左房参数在预测房颤患者卒中发生中的价值

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。

The value of left atrial parameters measured on cardiac CT in predicting stroke in patients with atrial fibrillation

Abstract: 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 stroke group and 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 the thrombus or circulatroy stasis in LAA was also observed.Observing weather there is a thrombus or stasis in the left atrium. We compared LA and LAA parameters in stroke group and non-stroke group. The independent association of these parameters from cardiac CT with the relation of stroke was evaluated with multivariate regression analysis.The relation between LA and LAA function and stroke was analyzed. Results 47 patients developed a stroke. The LAVmax and LAVmin in stroke group were significantly larger than those in non-stroke group(P<0.05), LAEF in stroke group decreased compared with non-stroke group (P<0.05); the proportion of non-chicken wing type in stroke group was higher than that in 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.