目的:心脏CT(CCT)是评估左心耳(LAA)血栓的新兴非侵入性方法,但是结果相互矛盾。我们的研究旨在评估CCT检测心房颤动导管消融患者左心耳血栓的准确性。使用经食管超声心动图(TEE)作为参考标准。
方法:病例对照研究。
方法:患者数据收集自2017年至2022年中国一家三级医院。
方法:该研究纳入了726例患者(男性:60.2%,年龄:61±11岁),在房颤导管消融术前同时进行TEE和CCT。
方法:CCT方案包括一个血管造影阶段和一个30秒后的延迟扫描。LAA血栓定义为TEE上的实性肿块或CCT上的持续性缺陷。血栓尺寸和位置,通过TEE评估左心耳充盈和排空流速。
结果:在经TEE鉴定的57例(7.9%)LAA血栓患者中,29个(50.9%)位于左心耳口,28例(49.1%)在左心耳中。前者在血流和心跳后表现出比后者更高的运动性。CCT检测到LAA口血栓14(48.3%),而LAA中检测到25(89.3%)(p=0.001)。LAA平均流速>0.35m/s且最大直径<10mm的LAA口血栓更容易出现CCT假阴性结果。
结论:对于接受心房颤动导管消融的患者,延迟扫描30s的CCT对左心耳血栓的敏感性低于TEE,特别是对于体积较小、左心耳流速较高的左心耳口血栓。
OBJECTIVE: Cardiac CT (CCT) is an emerging non-invasive modality for assessing left atrial appendage (LAA) thrombus, but the results were conflicting. Our study aims to evaluate the accuracy of CCT for detecting LAA thrombus in patients undergoing catheter ablation of atrial fibrillation, using trans-oesophageal echocardiography (TEE) as the reference standard.
METHODS: Case-control study.
METHODS: Patient data were collected from a tertiary hospital in China between 2017 and 2022.
METHODS: The study enrolled 726 patients (male: 60.2%, age: 61±11 years) who had both TEE and CCT before catheter ablation of atrial fibrillation.
METHODS: The CCT protocol consisted of one angiographic phase and one delayed scan 30 s later. LAA thrombi were defined as solid masses on TEE or persistent defects on CCT. The thrombus dimension and location, the LAA filling and emptying flow velocity were assessed by TEE.
RESULTS: Of the 57 (7.9%) patients with LAA thrombi identified by TEE, 29 (50.9%) were located at the LAA ostium, and 28 (49.1%) were in the LAA. The former showed higher motility following blood flow and heartbeats than the latter. The CCT detected 14 (48.3%) of the LAA-ostium thrombi but 25 (89.3%) of those in the LAA (p=0.001). The LAA-ostium thrombi with the LAA mean flow velocity >0.35 m/s and maximum diameters <10 mm were more prone to have CCT false-negative results.
CONCLUSIONS: For patients undergoing catheter ablation for atrial fibrillation, CCT with a 30 s delay scan is less sensitive to LAA thrombi than TEE, especially for LAA-ostium thrombi with smaller sizes and higher LAA flow velocity.