接受冠状动脉计算机断层扫描血管造影的心房颤动患者左心耳假血栓充盈缺损的患病率
Prevalence of left atrial appendage pseudothrombus filling defects in patients with atrial fibrillation undergoing coronary computed tomography angiography.
作者信息
Saremi Farhood, Channual Stephanie, Gurudevan Swaminatha V, Narula Jagat, Abolhoda Amir
机构信息
Department of Radiological Sciences, University of California Irvine, UCI Medical Center, Orange, CA 92868-3298, USA.
出版信息
J Cardiovasc Comput Tomogr. 2008 May-Jun;2(3):164-71. doi: 10.1016/j.jcct.2008.02.012. Epub 2008 Mar 4.
BACKGROUND
Previous reports have shown that computed tomography (CT) is a useful, noninvasive test for detecting atrial thrombi. However, blood stasis in the left atrial appendage (LAA) of patients with atrial fibrillation (AF) may be a common cause for false-positive results.
OBJECTIVES
We retrospectively evaluated the prevalence of filling defects that may simulate thrombus in the LAA of patients with AF during routine coronary CT angiography (CTA).
METHODS
The LAA of 7 patients with AF was studied for the presence of filling defects and compared with 250 healthy persons. LAA volume in the patients with AF was measured at 10 different cardiac phases and compared with 30 healthy patients.
RESULTS
Of the 7 patients with AF studied with CTA, 5 were positive for LAA filling defects. Follow-up imaging studies, including transesophageal echocardiogram, contrast-enhanced magnetic resonance angiography, or delayed-CT, were negative for LAA thrombus. Of 250 patients without AF, CTA showed no evidence of LAA filling defects. Patients with AF had significantly larger LAA volumes at all cardiac phases measured compared with patients without AF (15.2 +/- 6.93 mL compared with 6.85 +/- 3.01 mL at atrial contraction [P = 0.0187], 17.4 +/- 7.76 mL compared with 9.46 +/- 3.43 mL at ventricular systole [P = 0.0351], and 14.5 +/- 5.87 mL compared with 8.48 +/- 3.10 mL at mid-diastole [P = 0.0341]). Compared with the healthy persons, the patients with AF showed reduced percentages of change in LAA volume when the atrial contraction phase was compared with other phases: 44.0% +/- 25.6% compared with 16.5% +/- 12.2% compared with ventricular systole (P = 0.0004) and 29.5% +/- 23.7% compared with -1.63% +/- 8.84% at mid-diastole (P < 0.0001).
CONCLUSIONS
Pseudothrombus filling defects are common in the LAA of patients with AF undergoing coronary CTA and should not be mistaken for real thrombus.
背景
既往报道显示，计算机断层扫描（CT）是检测心房血栓的一种有用的无创检查方法。然而，心房颤动（AF）患者左心耳（LAA）内的血流淤滞可能是导致假阳性结果的常见原因。
目的
我们回顾性评估了在常规冠状动脉CT血管造影（CTA）期间，AF患者LAA中可能模拟血栓的充盈缺损的发生率。
方法
研究了7例AF患者的LAA有无充盈缺损，并与250名健康人进行比较。在10个不同心动周期测量AF患者的LAA容积，并与30名健康患者进行比较。
结果
在接受CTA检查的7例AF患者中，5例LAA充盈缺损呈阳性。包括经食管超声心动图、对比增强磁共振血管造影或延迟CT在内的随访影像学检查显示LAA血栓为阴性。在250例无AF的患者中，CTA未显示LAA充盈缺损的证据。与无AF的患者相比，AF患者在所有测量的心动周期中LAA容积均显著更大（心房收缩期时分别为15.2±6.93 mL和6.85±3.01 mL [P = 0.0187]，心室收缩期时分别为17.4±7.76 mL和9.46±3.43 mL [P = 0.0351]，舒张中期时分别为14.5±5.87 mL和8.48±3.10 mL [P = 0.0341]）。与健康人相比，AF患者心房收缩期与其他阶段相比LAA容积变化百分比降低：与心室收缩期相比分别为44.0%±25.6%和16.5%±12.2%（P = 0.0004），与舒张中期相比分别为29.5%±23.7%和 -1.63%±8.84%（P < 0.0001）。
结论
在接受冠状动脉CTA的AF患者中，假血栓充盈缺损在LAA中很常见，不应将其误诊为真正的血栓。
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