[1]吴阳 杨桂荣 张波 陈各才.双源CT在左心耳封堵术前评估及指导选择WatchmanTM封堵器型号的应用[J].心血管病学进展,2021,(4):374-379.[doi:10.16806/j.cnki.issn.1004-3934.2020.04.020]
　WU Yang,YANG Guirong,ZHANG Bo,et al.The Application of Dual Source CT in Preoperative Evaluation of Left Atrial Appendage Occlusion and Size Selection of Watchman TM Occluder.com[J].Advances in Cardiovascular Diseases,2021,(4):374-379.[doi:10.16806/j.cnki.issn.1004-3934.2020.04.020]
点击复制

双源CT在左心耳封堵术前评估及指导选择WatchmanTM封堵器型号的应用()
分享到：

《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2021年4期
页码:
374-379
栏目:
论著
出版日期:
2021-04-25

文章信息/Info

Title:
The Application of Dual Source CT in Preoperative Evaluation of Left Atrial Appendage Occlusion and Size Selection of Watchman TM Occluder.com
作者:
吴阳1; 2 杨桂荣 2 张波 3 陈各才 4
(1.大连医科大学研究生院 ,大连 辽宁 116000;2.泰州市人民医院超声医学科,泰州 江苏 225300;3.泰州市人民医院影像科,泰州 江苏 225300;4.泰州市人民医院心血管内科,泰州 江苏 225300)
Author(s):
WU Yang1; 2; YANG Guirong2; ZHANG Bo3; CHEN Gecai4?/html>
1.Dalian Medlical Uniersity Graduate School,Dalian 116000,Liaoning,China;2.Department of Melial Ulrasonics,Jiangsu Taizhou People’s Hospital,Taishou 225300,Jiangsu,China;3.Deparment of Medlical Image,Jiangsu Taizhou Pegple’s Hospial,Taizhou 225300, Jiangsu,China; 4.Department of Cardioascular Melicine,Jiangsu Taihou Peqple’s Hospital,Taizhou 225300,Jiangsu,China) hou 225300，Jiangsu，China)
关键词:
左心耳封堵术; 双源CT; 经食管超声心动图; 左心耳造影
Keywords:
Left atrial appendage occlusion ;  Dual source computed tomography;  Transesophageal echocardiography;  Left atrial appendage angiography
DOI:
10.16806/j.cnki.issn.1004-3934.2020.04.020
摘要:
目的 比较双源CT（DSCT）、经食道超声心动图（TEE）和左心耳造影在左心耳封堵术（LAAO）中的评估结果，研究DSCT指导LAAO的应用价值。方法 回顾性分析 接受LAAO的78例房颤患者，比较术前DSCT及TEE对左心耳（LAA）血栓的检出率，分析术前DSCT、术中TEE及LAA造影三者评估LAA最大开口、长度、预测WatchmanTM封堵器型号的准确率以及它们之间的相关性。结果 当DSCT增加60 s延迟显像时，与TEE的血栓检出率差异无统计学意义（P＞0.05），DSCT诊断血栓的敏感性为100%，特异性为98.6%，阳性预测率为80%，阴性预测率为100%，与TEE诊断血栓一致性的 Kappa 值为0.88（P＜0.01）；DSCT、TEE与LAA造影测量LAA最大开口的差异无统计学意义（P＞0.05），其测量最大开口分别为（23.07±4.21）mm、（22.87±3.70）mm和（22.52±3.76）mm，并且DSCT与TEE和LAA造影测量结果之间都有显著的相关性及一致性[ rTEE=0.812，P＜0.01，组内相关系数(ICC)=0.89(0.83～0.93) ; rLAA造影=0.802，P＜0.01，ICC=0.88(0.82～0.93)]；三种方法所预测的封堵器大小分别为DSCT:（26.92±3.94）mm、TEE:（26.88±3.73）mm和LAA造影:（26.96±3.73）mm，与实际植入大小（27.81±3.69）mm均具有显著的相关性及一致性[ rDSCT=0.886，P＜0.01，ICC=0.94(0.90～0.96)；rTEE=0.849，P＜0.01，ICC=0.92(0.87～0.95)；rLAA造影=0.924，P＜0.01，ICC=0.96(0.94～0.98)]； 在心耳最大长度测量方面[ DSCT:（27.22±4.72）mm、TEE:（25.76±4.58）mm和LAA造影:（24.12±3.88）mm]，三种方法的结果具有统计学差异（P＜0.05），DSCT对LAA长度测量结果大于TEE与LAA造影。结论 在LAAO治疗中，DSCT可在术前检出 患者的左心耳血栓，评估患者的手术适应症，同时准确测量心耳开口大小及长度，为预选封堵器型号提供重要的参考价值。
Abstract:
Objective To compare detection results of dual source computed tomography(DSCT),transesophageal echocardiography(TEE) and left atrial appendage angiography and investigate application va lue of DSCT in guiding left atrial appendage occlusion (LAAO). Methods A retrospective analysis was performed on 78 patients with atrial fibrillation who planned to undergo LAAO. LAA thrombosis detection rates from DSCT and TEE were compared before the operation. Accuracies of LAA maximal orifice diameter,length,size prediction of WatchmanTM occluder detected by preoperative DSCT,intraoperative TEE and LAA angiography and their correlations were assessed. Result When image delay of DSCT was increased by 60 s,there was no significant difference in thrombus detection of DSCT and TEE( P＞0.05). The sensitivity,specificity,positive predictive value and negative predictive value of LAA thrombus diagnosed by DSCT were 100.0%,98.6%,80.0%and 100.0% respectively,and the Kappa value representative of diagnostic consistency with TEE was 0.88(P＜0.01). The difference of LAA maximal orifice diameter measured by DSCT,TEE and LAA angiography was insignificant ( P＞0.05),with parallel maximal orifice diameter of (23.07±4.21)mm,(22.87±3.70)mm and ( 22.52±3.76)mm respectively. Results of DSCT were highly correlated and consistent with TEE and LAA angiography [rTEE=0.812,P＜0.01,ICC=0.89(0.83～0.93). r LAA angiography=0.802,P＜0.01,ICC=0.88(0.82～0.93)]. The predicted sizes of WatchmanTM occluders were (26.92±3.94) mm for DSCT,(26.88±3.73)mm for TEE and (26.96±3.73)mm for LAA angiography respectively,which were markedly correlated and consistent with actual implant size of (27.81±3.69)mm[rDSCT=0.886,P＜0.01,ICC=0.94(0.90～0.96);rTEE=0.849,P＜0.01,ICC=0.92(0.87～0.95); rLAA angiography=0.924,P＜0.01,ICC=0.96(0.94～0.98)]. There exist statistical difference in LAA maximal lengths detected by three imaging modalities[(27.22±4.72)mm for DSCT, (25.76±4.58)mm for TEE and (24.12±3.88)mm for LAA angiography, P＜0.05],of which LAA length detected by DSCT was larger than TEE and LAA angiography. Conclusion DSCT may help to detect LAA thrombus and assess indications before operation in LAAO treatment,as well as provide vital reference on size selection of WatchmanTM occluder by precis ely measuring the size and length of auricular orifice.

参考文献/References:

[1].Eng MH,Wang DD. Computed Tomography for Left Atrial Appendage Occlusion Case Planning[J]. Interv Cardiol Clin,2018,7(3):367-378.
[2].王学成,杨兵.心房颤动导管消融联合左心耳封堵的临床应用进展[J].心血管病学进展,2019,40(4):493-497.
[3].Kirchhof P,Benussi S,Kotecha D,et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS[J]. Europace,2016,18(11):1609-1678.
[4].Korsholm K,Berti S,Iriart X,et al. Expert recommendations on cardiac computed tomography for planning transcatheter left atrial appendage occlusion[J]. JACC Cardiovasc Interv,2020,13(3):277-292.
[5].Ali M,Rigopoulos AG,Mammadov M,et al. Systematic review on left atrial appendage closure with the LAmbre device in patients with non-valvular atrial fibrillation[J]. BMC Cardiovasc Disord,2020,20(1):78.
[6].Lip GY,Fauchier L,Freedman SB,et al. Atrial fibrillation[J]. Nat Rev Dis Primers,2016,2:16016.
[7].中华医学会心血管病学分会,中华心血管病杂志编辑委员会. 中国左心耳封堵预防心房颤动卒中专家共识 (2019)[J]. 中华心血管病杂志 ,2019,47(12):937-955.
[8].袁知东,石桥,冯飞,等. 256排CT冠状动脉成像延迟扫描诊断房颤患者左心耳血栓的价值[J]. 中国 CT和MRI杂志,2019,17(8):42-44.
[9].朱世杰,郑慕晗,张建武,等. 心脏 CT在左心耳封堵术中的应用价值[J]. 心血管病学进展 ,2020,41(1):11-14.
[10].苗雨桐,何奔. 影像学在左心耳封堵中的意义 [J]. 心血管病学进展 ,2019,40(4):497-501．
[11].丛涛,王珂,孙颖慧,等. 增强 CT与经食管超声心动图诊断房颤患者左心房/左心耳内血栓的比较[J]. 临床和实验医学杂志 ,2010,9(10):723-725.
[12].段利科,张周龙. 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[J]. 中国 CT和MRI杂志,2019,17(4):59-61,119.
[13].Chow DH,Bieliauskas G,Sawaya FJ,et al. A comparative study of different imaging modalities for successful percutaneous left atrial appendage closure[J]. Open Heart,2017,4(2):e627.
[14].Xu B,Betancor J,Sato K,et al. Computed tomography measurement of the left atrial appendage for optimal sizing of the Watchman device[J]. J Cardiovasc Comput Tomogr,2018,12(1):50-55.
[15].张涛,陈立斌,储慧民,等. 经食管超声心动图及 CT左心耳造影在左心耳Watchman封堵术前的应用价值[J]. 中华超声影像学杂志 ,2017,26(11):964-969.
[16].Spencer RJ,DeJong P,Fahmy P,et al. Changes in left atrial appendage dimensions following volume loading during percutaneous left atrial appendage closure[J]. JACC Cardiovasc Interv,2015,8(15):1935-1941.
[17].任继来,王学成,仲程豪,等. 经食管超声心动图、双源 CT及左心耳造影对左心耳封堵器型号选择的价值[J]. 中华心律失常学杂志 ,2019,23(5):430-435.
[18].Wang DD,Eng M,Kupsky D,et al. Application of 3-dimensional computed tomographic image guidance to WATCHMAN implantation and impact on early operator learning curve: single-center experience[J]. JACC Cardiovasc Interv,2016,9(22):2329-2340.
[19].Pracon R,Bangalore S,Dzielinska Z,et al. Device thrombosis after percutaneous left atrial appendage occlusion is related to patient and procedural characteristics but not to duration of postimplantation dual antiplatelet therapy[J]. Circ Cardiovasc Interv,2018,11(3):e5997.
[20].Meier B. What Lies Beneath Left Atrial Appendage Occlusion: Know Your Enemy[J]. Circ Cardiovasc Interv,2018,11(3):e6360.
[21].Toy D,Naeger DM. pre and post procedure imaging of the Watchman? device with cardiac computed tomography angiography[J]. Curr Treat Options Cardiovasc Med,2019,21(10):61.

相似文献/References:

[1]安硕研,郑金刚.左心耳封堵术预防心源性卒中的进展[J].心血管病学进展,2019,(6):869.[doi:10.16806/j.cnki.issn.1004-3934.2019.06.008]
　AN Shuoyan,ZHENG Jingang.Left Atrial Appendage Closure for Prevention of Cardiogenic Stroke[J].Advances in Cardiovascular Diseases,2019,(4):869.[doi:10.16806/j.cnki.issn.1004-3934.2019.06.008]
[2]彭金华,王平,胡婧,等.左心耳封堵术对非瓣膜性心房颤动患者心脏利尿钠肽分泌功能的影响[J].心血管病学进展,2019,(6):873.[doi:10.16806/j.cnki.issn.1004-3934.2019.06.009]
　PENG Jinhua,WANG PingHU Jing,YANG Jingqi,et al.Effect of Left Atrial Appendage Closure on Cardiac Natriuretic Peptide Secretion in Patients with Nonvalvular Atrial Fibrillation[J].Advances in Cardiovascular Diseases,2019,(4):873.[doi:10.16806/j.cnki.issn.1004-3934.2019.06.009]
[3]朱洪基,余建群,彭礼清.心电门控双源CTPA评价急性肺栓塞及其右心室功能[J].心血管病学进展,2019,(6):955.[doi:10.16806/j.cnki.issn.1004-3934.2019.06.029]
　ZHU Hongji,YU Jianqun,PENG Liqing.Evaluation of Acute Pulmonary Embolism and Its Right Ventricular Function by ECG Gated Dual-source CTPA[J].Advances in Cardiovascular Diseases,2019,(4):955.[doi:10.16806/j.cnki.issn.1004-3934.2019.06.029]
[4]朱世杰,郑慕晗,张建武,等.心脏CT在左心耳封堵术中的应用价值[J].心血管病学进展,2020,(1):11.[doi:10.16806/j.cnki.issn.1004-3934.2020.01.004]
　ZHU Shijie,ZHENG Muhan,ZHANG Jianwu,et al.Application of Cardiac CT in Left Atrial Appendage Closure[J].Advances in Cardiovascular Diseases,2020,(4):11.[doi:10.16806/j.cnki.issn.1004-3934.2020.01.004]
[5]金铁托 阮中宝.左心耳封堵术对患者系统内稳态的影响[J].心血管病学进展,2020,(12):1268.[doi:10.16806/j.cnki.issn.1004-3934.2020.12.011]
　JIN Tietuo,RUAN Zhongbao.Effect of Left Atrial Appendage Closure on Systemic Homeostasis in Patients[J].Advances in Cardiovascular Diseases,2020,(4):1268.[doi:10.16806/j.cnki.issn.1004-3934.2020.12.011]
[6]李亚会 黄从新.左心耳封堵术常见并发症及其防治[J].心血管病学进展,2021,(5):408.[doi:10.16806/j.cnki.issn.1004-3934.2021.05.006]
　LI YahuiHUANG Congxin.Common Complications of Left Atrial Appendage Occlusion and Its Prevention and Treatment[J].Advances in Cardiovascular Diseases,2021,(4):408.[doi:10.16806/j.cnki.issn.1004-3934.2021.05.006]
[7]柏懿璇 崔凯军.左心耳封堵术后装置相关血栓[J].心血管病学进展,2022,(5):407.[doi:10.16806/j.cnki.issn.1004-3934.2022.05.006]
　BAI Yixuan,CUI Kaijun.Device-Related Thrombus After Left Atrial Appendage Occlusion[J].Advances in Cardiovascular Diseases,2022,(4):407.[doi:10.16806/j.cnki.issn.1004-3934.2022.05.006]
[8]王璐 李耀东.TAVR合并心房颤动抗凝策略的研究进展[J].心血管病学进展,2022,(8):695.[doi:10.16806/j.cnki.issn.1004-3934.2022.08.007]
　WANG Lu,LI Yaodong.Anticoagulation Strategy in Patients After TAVR Complicated with Atrial Fibrillation[J].Advances in Cardiovascular Diseases,2022,(4):695.[doi:10.16806/j.cnki.issn.1004-3934.2022.08.007]
[9]魏志梁 孙雨可 尹月娇 孙守刚.心房颤动合并慢性肾脏病患者的左心耳封堵治疗研究进展[J].心血管病学进展,2022,(9):783.[doi:10.16806/j.cnki.issn.1004-3934.2022.09.005]
　WEI Zhiliang,SUN Yuke,YIN Yuejiao,et al.Left Atrial Appendage Closure in Patients with Atrial Fibrillation Complicated with Chronic Kidney Disease[J].Advances in Cardiovascular Diseases,2022,(4):783.[doi:10.16806/j.cnki.issn.1004-3934.2022.09.005]
[10]邓蕊 李洪仕 蔡衡.左心耳封堵术对非瓣膜性心房颤动合并冠状动脉性心脏病的价值[J].心血管病学进展,2022,(11):966.[doi:10.16806/j.cnki.issn.1004-3934.2022.11.002]
　DENG Rui,LI Hongshi,CAI Heng.Value of Left Atrial Appendage Closure on Non-Valvular Atrial Fibrillation with Coronary Heart Disease[J].Advances in Cardiovascular Diseases,2022,(4):966.[doi:10.16806/j.cnki.issn.1004-3934.2022.11.002]

备注/Memo

备注/Memo:
通信作者：陈各才，E-mail：chengecai@163.com
收稿时间：2020-08-09
更新日期/Last Update: 2021-07-01