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三种影像学测量技术对左心耳封堵器尺寸选择的指导价值

刘阁 陈韬 穆洋 韩宝石 朱航 汪奇 郭豫涛 陈韵岱 郭军

刘阁, 陈韬, 穆洋, 韩宝石, 朱航, 汪奇, 郭豫涛, 陈韵岱, 郭军. 三种影像学测量技术对左心耳封堵器尺寸选择的指导价值[J]. 协和医学杂志, 2020, 11(1): 21-26. doi: 10.3969/j.issn.1674-9081.20190196
引用本文: 刘阁, 陈韬, 穆洋, 韩宝石, 朱航, 汪奇, 郭豫涛, 陈韵岱, 郭军. 三种影像学测量技术对左心耳封堵器尺寸选择的指导价值[J]. 协和医学杂志, 2020, 11(1): 21-26. doi: 10.3969/j.issn.1674-9081.20190196
Ge LIU, Tao CHEN, Yang MU, Bao-shi HAN, Hang ZHU, Qi WANG, Yu-tao GUO, Yun-dai CHEN, Jun GUO. Value of Three Imaging Modalities for the Size Selection of Left Atrial Appendage Closure Device[J]. Medical Journal of Peking Union Medical College Hospital, 2020, 11(1): 21-26. doi: 10.3969/j.issn.1674-9081.20190196
Citation: Ge LIU, Tao CHEN, Yang MU, Bao-shi HAN, Hang ZHU, Qi WANG, Yu-tao GUO, Yun-dai CHEN, Jun GUO. Value of Three Imaging Modalities for the Size Selection of Left Atrial Appendage Closure Device[J]. Medical Journal of Peking Union Medical College Hospital, 2020, 11(1): 21-26. doi: 10.3969/j.issn.1674-9081.20190196

三种影像学测量技术对左心耳封堵器尺寸选择的指导价值

doi: 10.3969/j.issn.1674-9081.20190196
基金项目: 

国家重点研发计划 2018YFC2001200

北京市科技新星项目 Z18100006218120

全军青年人才托举计划 17-JCJQ-QT-029

详细信息
    通讯作者:

    郭军 电话:010-55499311, E-mail:guojun301@hotmail.com

  • 中图分类号: R541.7+5;R814.42;R814.43;R540.4+5

Value of Three Imaging Modalities for the Size Selection of Left Atrial Appendage Closure Device

More Information
  • 摘要:   目的  初步探讨CT血管造影(CT angiography, CTA)、经食管超声心动图(transesophageal echocardio-graphy, TEE)和术中数字减影血管造影(digital subtraction angiography, DSA)3种方法测量左心耳开口直径对选择适宜尺寸左心耳封堵器的指导价值。  方法  回顾性收集2015年12月1日至2019年3月31日在解放军总医院第一医学中心接受经皮左心耳封堵术的非瓣膜性房颤患者临床资料。所有入选患者同时采用CTA、TEE、DSA 3种方法测量左心耳开口直径, 记录植入封堵器尺寸, 采用Pearson相关性分析比较3种方法测量值与植入封堵器尺寸的相关性, 采用Bland-Altman一致性分析法比较3种方法测量值与所植入封堵器尺寸的一致性。  结果  共102例符合纳入和排除标准的患者入选本研究, 均成功植入WATCHMAN封堵器。平均年龄(70.1±9.8)岁, CHA2DS2-VASc评分(评估非瓣膜性房颤成年患者发生卒中的风险)为(5.11±1.43)分, HAS-BLED评分(评估出血风险)(3.61±1.18)分。CTA测量左心耳开口直径[(22.51±3.55)mm]与DSA[(22.22±3.73)mm]接近, 无统计学差异(q=0.81, P=0.12), 两种方法的测量值均大于TEE[(20.82±0.36)mm, P均 < 0.01]。封堵器尺寸与CTA、DSA、TEE测量的左心耳开口直径呈正相关(r=0.93、0.87、0.83, P均 < 0.01)。封堵器尺寸与CTA测量值的一致性界限最窄(-7.83 mm, -2.56 mm), 差值为(-5.19±1.35)mm, 95%置信区间为(-5.46 mm, -4.93 mm); 与TEE测量值的一致性界限最宽(-11.00 mm, -2.77 mm), 差值为(-6.88±2.10)mm, 95%置信区间为(-7.29 mm, -6.47 mm)。  结论  CTA、DSA、TEE测量左心耳开口直径能为选择左心耳封堵器适宜尺寸提供较好依据, 其中CTA测量值与封堵器尺寸的相关性和一致性最佳。
    利益冲突  无
  • 图  1  经食管超声心动图在0°(A)、45°(B)、90°(C)及135°(D)4个切面分别测量左心耳开口直径

    图  2  借助CT血管造影技术采用多平面重建法测量左心耳开口直径

    A.斜冠状位左心耳开口图像;B.图A的正交平面;C.图A横断面,即左心耳开口截面图像,在此截面测得的最大径为左心耳开口直径

    图  3  数字减影血管造影术中在右前斜位30° +足位20°测量左心耳开口直径

    图  4  CT血管造影(A)、数字减影血管造影(B)、经食管超声心动图(C)3种测量方法测得左心耳开口径与植入封堵器尺寸的相关性分析

    图  5  CT血管造影(A)、数字减影血管造影(B)、经食管超声心动图(C) 3种测量方法测量值与植入封堵器尺寸的一致性分析

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出版历程
  • 收稿日期:  2019-09-16
  • 刊出日期:  2020-01-30

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