Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
Int J Cardiovasc Imaging. 2023 Mar;39(3):659-666. doi: 10.1007/s10554-022-02748-z. Epub 2022 Nov 3.
This study seeks to propose and compare different quantitative evaluation methods for identifying patients with peri-device leak (PDL) using cardiac computed tomography angiography (CCTA). Patients who had undergone left atrial appendage (LAA) closure and both transesophageal echocardiography (TEE) and CCTA were enrolled. Hounsfield units (HU) were measured in the proximal and distal regions of the left atrial appendage (p-LAA, d-LAA) on the CCTA, and the average of the two was determined (a-LAA). The relative HU ratios of the LAA to the center of the left atrium (LA) were calculated (p-LAA/c-LA, d-LAA/c-LA, a-LAA/c-LA). The area under the curve (AUC) for the LAA HU and the LAA/LA HU ratio were analyzed and compared. Fifty-one patients were included in this study. Pairwise comparisons showed a statistically significant difference (p = 0.029) in diagnostic performance between the d-LAA (AUC = 0.868) and a-LAA (AUC = 0.972). There were no significant differences between the a-LAA and p-LAA (p = 0.549) or between the d-LAA and p-LAA (p = 0.053). At the optimal cutoff for a-LAA of 115.5 HU, the sensitivity was 100%, the specificity was 88%. At the optimal cutoff for p-LAA of 109 HU, the sensitivity was 100%, the specificity was 84%. The LAA/LA HU ratio did not exhibit better diagnostic performance than HU attenuation in the LAA (p > 0.05). The a-LAA > 115.5 is useful in identifying PDL. Due to its convenience and intuitiveness, p-LAA > 109.0 can also be used as an alternative protocol for a-LAA.
本研究旨在提出并比较使用心脏计算机断层扫描血管造影术（CCTA）识别经心尖左心耳（LAA）封堵术后器械周围漏（PDL）患者的不同定量评估方法。入选行 LAA 封堵术并同时接受经食管超声心动图（TEE）和 CCTA 检查的患者。在 CCTA 上测量 LAA 近端（p-LAA）和远端（d-LAA）的 CT 值（HU），并取两者的平均值（a-LAA）。计算 LAA 与左心房中心（LA）的相对 HU 比值（p-LAA/c-LA、d-LAA/c-LA、a-LAA/c-LA）。分析并比较 LAA HU 和 LAA/LA HU 比值的曲线下面积（AUC）。本研究共纳入 51 例患者。两两比较显示，d-LAA（AUC=0.868）和 a-LAA（AUC=0.972）之间的诊断性能存在统计学差异（p=0.029）。a-LAA 与 p-LAA（p=0.549）或 d-LAA 与 p-LAA（p=0.053）之间无显著差异。当 a-LAA 的最佳截断值为 115.5 HU 时，敏感性为 100%，特异性为 88%。当 p-LAA 的最佳截断值为 109 HU 时，敏感性为 100%，特异性为 84%。LAA/LA HU 比值的诊断性能并不优于 LAA 中的 HU 衰减（p>0.05）。a-LAA>115.5 有助于识别 PDL。由于其方便性和直观性，p-LAA>109.0 也可作为 a-LAA 的替代方案。
