Kim In Cheol, Chang Hyuk Jae, Cho In Jeong, Shim Chi Young, Hong Geu Ru, Heo Ji Hoe, Nam Hyo Suk, Kim Young Jin, Choi Byoung Wook, Chung Namsik
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Division of Cardiology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea.
Korean Circ J. 2019 Feb;49(2):173-180. doi: 10.4070/kcj.2018.0152. Epub 2018 Nov 5.
Decreased left atrial appendage (LAA) emptying velocity in transesophageal echocardiography (TEE) is related with higher incidence of thrombus and increased risk of stroke. Patients with valve disease are at higher risk of thrombus formation before and after surgery. The aim of this study was to investigate the role of 4-dimensional cardiac computed tomography (4DCT) to predict the risk of thrombus formation.
Between March 2010 to March 2015, total of 62 patients (mean 60±15 years old, male: 53.2%) who underwent 4DCT and TEE for cardiac valve evaluation before surgery were retrospectively included in the current study. Fractional area change in TEE view and emptying velocity at left atrial appendage in TEE view (Ve) were measured. Ejection fraction (EF) of left atrial appendage in computed tomography (EF) was calculated by 4DCT with full volume analysis. The best cut-off value of EF predicting presence of spontaneous echo contrast (SEC) or thrombus was evaluated, and correlation between the parameters were also estimated.
SEC or thrombus was observed in 45.2%. EF and Ve were significantly correlated (r=0.452, p<0.001). However, fractional area change measured by TEE showed no correlation with Ve (r=0.085, p=0.512). EF <37.5% best predicted SEC or thrombus in the patients with valve disease who underwent 4DCT and TEE (area under the curve, 0.654; p=0.038).
In the patients who underwent 4DCT for cardiac valve evaluation before surgery, EF by volume analysis might have additional role to evaluate LAA function and estimate the risk of thrombus.
经食管超声心动图（TEE）检查发现左心耳（LAA）排空速度降低与血栓形成发生率较高及中风风险增加相关。瓣膜病患者在手术前后发生血栓形成的风险较高。本研究旨在探讨四维心脏计算机断层扫描（4DCT）在预测血栓形成风险中的作用。
回顾性纳入2010年3月至2015年3月期间62例（平均年龄60±15岁，男性占53.2%）在手术前行4DCT和TEE进行心脏瓣膜评估的患者。测量TEE视图中的面积变化分数以及TEE视图中左心耳的排空速度（Ve）。通过4DCT全容积分析计算计算机断层扫描中左心耳的射血分数（EF）。评估预测自发回声增强（SEC）或血栓存在的EF最佳截断值，并估计各参数之间的相关性。
观察到45.2%的患者存在SEC或血栓。EF与Ve显著相关（r = 0.452，p < 0.001）。然而，TEE测量的面积变化分数与Ve无相关性（r = 0.085，p = 0.512）。EF < 37.5%对接受4DCT和TEE检查的瓣膜病患者的SEC或血栓具有最佳预测价值（曲线下面积，0.654；p = 0.038）。
对于手术前行4DCT进行心脏瓣膜评估的患者，通过容积分析得出的EF可能在评估LAA功能和估计血栓风险方面具有额外作用。
