64层螺旋CT检测老年心房颤动患者左心耳血栓的价值

目的探讨导管射频消融术前,应用64层螺旋CT检测老年心房颤动患者左心耳血栓的临床价值。方法对102例拟行导管射频消融术的老年心房颤动患者进行心脏64层螺旋CT扫描,并于1周内,经食管超声心动图(TEE)检查。以TEE为参照标准,评价64层螺旋CT诊断患者左心耳血栓的敏感性、特异性、阳性预测值、阴性预测值及准确度,应用κ检验2种方法的一致性。结果 102例患者中,64层螺旋CT检查显示左心耳血栓形成者16例,其中11例经TEE证实,另5例为自发超声显影;64层螺旋CT检查未见血栓征象者86例,其中84例经TEE证实,另2例TEE显示为血栓。64层螺旋CT诊断左心耳血栓的敏感性84.6%,特异性94.4%,阳性预测值68.8%,阴性预测值97.7%,准确度93.1%,2种方法检测左心耳血栓具有较高的一致性(κ=0.724)。结论 64层螺旋CT检测老年心房颤动患者左心耳血栓具有较高的应用价值,未来有可能成为临床上检测左心耳血栓的一种无创、可靠的替代方法。

The value of 64-slice spiral CT in detection of left atrial appendage thrombus in the elderly patients with atrial fibrillation

Objective To evaluate the value of 64-slice spiral CT in detection of left atrial appendage (LAA) thrombus before ablation of atrial fibrillation(AF) in elderly.Methods 64-slice spiral CT scanning was performed in 102 patients with AF before catheter ablation.All patients underwent transesophageal echocardiography (TEE) as a reference standard in one week.According to the results of TEE,the sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV) and accuracy of 64-slice spiral CT in detection of LAA thrombus in elderly were evaluated. Results Sixteen thrombi in LAA were detected with 64-slice spiral CT,of which 11 were detected with TEE,and spontaneous echo contrast was detected with TEE in the other 5 patients. With TEE used as the reference standard,the overall sensitivity,specificity,and accuracy of 64-slice spiral CT for detecting thrombus were 84.6% ,94.4% ,and 93.1% respectively.The concordance between LAA thrombus detection with 64-slice spiral CT and with TEE was high:84 patients with no thrombus detected by both 64-slice spiral CT and TEE; 11 patients with LAA thrombus detected by both CT and TEE,and 2 patients with thrombus detected by TEE but not by 64-slice spiral CT(overall κ=0.724).The PPV and NPV of 64-slice spiral CT for detecting LAA thrombus were 68.8% and 97.7 % ,respectively.Conclusions The 64-slice spiral CT is an effective modality for detecting LAA thrombus in the elderly patients with AF,which has the potential to become a noninvasive and reliable alternative for the detection of LAA thrombus.