Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan; Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Am J Cardiol. 2022 Oct 1;180:29-36. doi: 10.1016/j.amjcard.2022.06.009. Epub 2022 Jul 18.
Filling defect (FD) in left atrial appendage (LAA) is commonly observed in contrast computed tomography (CT) among patients with atrial fibrillation (AF), although its prognostic impact has not been well explored. We enrolled 1,019 consecutive patients who underwent AF ablation with baseline contrast CT images. FD in LAA was graded into 3 groups: grade 0 for complete filling (79.7%), grade 1 for incomplete filling (12.6%), and grade 2 for complete FD (7.8%). We evaluated the impact of the FD grade on the long-term clinical outcomes during the mean follow-up of 4.4 ± 2.0 years. Patients with grade 2 FD had higher prevalence of nonparoxysmal AF, higher brain natriuretic peptide level, and larger left atrial volume than those with grade 0 or 1 FD. The 5-year cumulative incidence of recurrent atrial tachyarrhythmias was higher in patients with grade 2 FD than those with grade 0 or 1 FD (74.0% vs 38.8% and 62.1%, log-rank p <0.001). The 5-year cumulative incidence of major adverse cardiovascular events (MACEs), defined as a composite of all-cause death, heart failure hospitalization, and ischemic stroke, was also significantly higher in patients with grade 2 FD (19.4% vs 5.6% and 9.5%, log-rank p <0.001). Follow-up CT images acquired in 87.1% of patients at median interval of 98 days showed significantly decreased FD (grade 1 in 4.5% and grade 2 in 2.1%, p <0.001). The residual grade 2 FD at follow-up was associated with significantly higher risk for subsequent MACEs. In conclusion, among patients with AF receiving catheter ablation, severe FD in LAA in contrast CT was associated with higher incidence of arrhythmia recurrence and MACEs during follow-up.
左心耳（LAA）充盈缺损（FD）在房颤（AF）患者的对比增强计算机断层扫描（CT）中很常见，但尚未充分探讨其预后影响。我们纳入了 1019 例连续接受 AF 消融术的患者，这些患者在基线时均进行了对比 CT 检查。LAA 的 FD 分为 3 组：完全充盈（79.7%）、不完全充盈（12.6%）和完全 FD（7.8%）。我们评估了 FD 分级对平均随访 4.4±2.0 年期间长期临床结局的影响。与 FD 分级 0 或 1 的患者相比，FD 分级 2 的患者中非阵发性 AF 更常见、脑利钠肽水平更高、左心房容积更大。与 FD 分级 0 或 1 的患者相比，FD 分级 2 的患者发生复发性房性心律失常的 5 年累积发生率更高（74.0%比 38.8%和 62.1%，log-rank p <0.001）。FD 分级 2 的患者发生主要不良心血管事件（MACEs）的 5 年累积发生率也明显更高（定义为全因死亡、心力衰竭住院和缺血性卒中的复合终点）（19.4%比 5.6%和 9.5%，log-rank p <0.001）。在中位时间为 98 天的 87.1%的患者中进行了随访 CT 检查，结果显示 FD 明显减少（分级 1 占 4.5%，分级 2 占 2.1%，p <0.001）。随访时残留的 FD 分级 2 与随后发生 MACEs的风险显著相关。总之，在接受导管消融术的 AF 患者中，对比 CT 显示 LAA 严重 FD 与随访期间心律失常复发和 MACEs 的发生率较高相关。
