术前心脏CT血管成像左心耳形态学评价对房颤患者左心耳封堵术后残余分流发生的危险因素分析

胡斌; 丁宁宁; 刘哲; 王星烨; 刘辉; 荐志洁

doi:10.12125/j.chj.202210113

术前心脏CT血管成像左心耳形态学评价对房颤患者左心耳封堵术后残余分流发生的危险因素分析

Predictive value of left atrial appendage morphology based on preoperative cardiac computed tomography angiography for peri-device leak after left atrial appendage closure in patients with atrial fibrillation

摘要

摘要:
目的探究房颤患者左心耳封堵（LAAC）术后残余分流（PDL）发生率，分析基于术前心脏CT血管成像（CCTA）左心耳形态学指标中与房颤患者LAAC术后PDL发生的潜在危险因素。
方法选择西安交通大学第一附属医院2021年6月～2022年6月间成功实施LAAC的房颤患者72例，收集其临床资料，评估术前CCTA图像左心房与左心耳形态学指标。根据LAAC术后45 d 复查结果将其分为PDL组（n=29）及无PDL组（n=43）。对两组患者之间差异具有统计学意义的术前指标进行Logistic 回归分析，寻找危险因素。
结果 PDL组LAA孔口长径（35 ± 5）mm vs. （31 ± 7） mm， P<0.01、短径（26 ± 6）mm vs. （22 ± 4） mm，P<0.01、着陆区面积（576±166） mm² vs. （480 ± 161） mm²，P<0.05均大于无PDL组，梳状肌发达率较无PDL组有统计学差异（P<0.05）。PDL组左心房及左心耳体积、着陆区直径、左心耳深度较无PDL组大，但两组间无统计学差异，左心耳孔口形状、左心耳形态及分叶等定性指标在两组间也无统计学差异。将组间比较有统计学差异的指标纳入单因素Logistic回归进行分析，结果显示LAA孔口长径（OR=1.118，95%CI：1.024~1.220，P<0.05）、短径（OR=1.200，95%CI：1.073~1.343，P<0.01）、着陆区面积（OR=1.004，95%CI：1.000~1.007，P<0.05）及梳状肌发达程度（OR=3.580，95%CI：1.314~9.756，P<0.05）均与术后PDL相关。经多因素Logistic回归校正后，LAA孔口短径与梳状肌发达程度为PDL的独立危险因素。
结论术前CCTA左心耳形态学评估对房颤患者LAAC术后PDL的发生具有一定的预测价值，当梳状肌较发达、左心耳口部短径较大时，需警惕PDL的发生。

Abstract:
AIM To assess the incidence of peri-device leak (PDL) after left atrial appendage closure (LAAC) and the predictive value of left atrial appendage (LAA) morphology based on preoperative cardiac computed tomography angiography (CCTA) for PDL in patients with atrial fibrillation.
METHODS Seventy-two patients with atrial fibrillation who underwent LAAC successfully in our hospital from June 2021 to June 2022 were enrolled retrospectively and their clinical and image data were collected. Their preoprative CCTA images were analyzed for parameters of LA and LAA. The patients were classified into PDL group (n=29) and no-PDL group (n=43) based on reexamination 45 days after LAAC. Logistic regression analysis was performed to find the risk factors for PDL among the parameters with statistically significant differences between the two groups.
RESULTS The long diameter (35 ± 5) mm vs. (31 ± 7) mm, P<0.01, short diameter (26 ± 6) mm vs. (22 ± 4) mm, P<0.01, landing area (576 ± 166) mm² vs. (480 ± 161) mm², P<0.05 in PDL group were larger than these in non PDL group, and the pectinate muscles were statistical difference between the two groups (P<0.05). The volume of left atrium and left atrial appendage, the diameter of landing area, and the depth of left atrial appendage in PDL group were larger than those in non PDL group, but there was no statistical difference between the two groups. The indicators with statistical differences between groups were included in the single factor logistic regression analysis. The results showed that the LAA orifice long diameter (OR=1.118, 95% CI: 1.024~1.220, P<0.05), short diameter (OR=1.200, 95% CI: 1.073~1.343, P<0.01), landing area (OR=1.004, 95% CI: 1.000~1.007, P<0.05) and comb muscle development (OR=3.580, 95% CI: 1.314~9.756, P<0.05) were all related to postoperative PDL. After multivariate logistic regression correction, the short diameter of LAA orifice and the degree of comb muscle development were independent risk factors for PDL.
CONCLUSION The development of pectinate muscles and short diameter of LAA orifice on preoperative CCTA has potential predictive value for postoperative PDL in patients with atrial fibrillation. Well developed pectinate muscles and large short diameter of LAA orifice are risk factors for the occurrence of PDL following LAAC.

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