Departments of Cardiology of Zhongshan Hospital Wusong Branch, Fudan University, Shanghai, China.
Departments of Radiology Zhongshan Hospital Wusong Branch, Fudan University, Shanghai, China.
J Cardiovasc Electrophysiol. 2024 Mar;35(3):389-398. doi: 10.1111/jce.16176. Epub 2024 Jan 8.
This study was performed to explore the diagnostic value of cardiac computed tomography angiography (CCTA) for endothelial insufficiency (EIS) of a left atrial appendage (LAA) disc-like occluder.
Fifty-nine patients with nonvalvular atrial fibrillation who underwent placement of an LAA disc-like occluder (LAmbre; Lifetech Scientific) in our hospital were retrospectively analyzed. Patients who were found to have contrast agent entering the LAA at the 3-month postoperative CCTA examination underwent Hounsfield unit (HU) measurement of the LAA and construction of a three-dimensional (3D) model of the device for preliminary discernment between peri-device leakage (PDL) and EIS. These patients were then further examined by transesophageal echocardiography (TEE) to check for concordance with the computed tomography (CT) findings. According to the CT and TEE results, all patients were divided into the PDL group, total endothelialization group, and EIS group. The endothelial conditions and other implantation-related results were also tracked at the 6-month follow-up.
All 59 patients underwent successful implantation of the LAmbre LAA closure device with no severe adverse events during the procedure. Thirty-five patients were found to have contrast agent entering the LAA at the 3-month postoperative CCTA follow-up. Based on the CT HU measurement and the 3D construction analysis results, these 35 patients were divided into the PDL group (19 patients) and the EIS group (16 patients). In the PDL group, the contrast agent infiltrated from the shoulder along the periphery of the occluder on two-dimensional (2D) CT images, and the 3D model showed a gap between the LAA and the device cover. However, the CCTA images of the other 16 patients in the EIS group showed that the contrast agent in the occluder on the 2D CTA images and 3D construction model confirmed the absence of a gap between the LAA and the device cover. TEE confirmed all of the CT results. The 6-month follow-up results showed that 14 of 19 patients in the EIS group achieved total endothelialization, whereas this number in the PDL group was only five of 19 patients.
CCTA can replace TEE for examination of the endothelialization status, and patients with EIS have a higher chance of endothelialization than patients with PDL.
本研究旨在探讨心脏计算机断层血管造影术（CCTA）在诊断左心耳（LAA）盘状封堵器内皮功能不全（EIS）中的价值。
回顾性分析我院 59 例行 LAA 盘状封堵器（LAmbre；Lifetech Scientific）置入的非瓣膜性心房颤动患者。术后 3 个月 CCTA 检查发现对比剂进入 LAA 的患者，行 LAA 亨氏单位（HU）测量，并构建装置的三维（3D）模型，初步判断器械周围漏（PDL）与 EIS 之间的差异。然后对这些患者进行经食管超声心动图（TEE）检查，以与 CT 结果进行一致性检查。根据 CT 和 TEE 结果，所有患者分为 PDL 组、完全内皮化组和 EIS 组。在 6 个月的随访中，还跟踪了内皮状况和其他植入相关结果。
所有 59 例患者均成功植入 LAmbre LAA 封堵器，术中无严重不良事件。术后 3 个月 CCTA 随访发现 35 例患者对比剂进入 LAA。根据 CT HU 测量和 3D 构建分析结果，这 35 例患者分为 PDL 组（19 例）和 EIS 组（16 例）。在 PDL 组，二维（2D）CT 图像上对比剂从肩部沿封堵器周边渗透，3D 模型显示 LAA 和器械覆盖物之间存在间隙。然而，EIS 组的另 16 例患者的 CCTA 图像显示，2D CTA 图像和 3D 构建模型上的封堵器内的对比剂证实 LAA 和器械覆盖物之间没有间隙。TEE 证实了所有 CT 结果。6 个月随访结果显示，EIS 组 19 例患者中有 14 例达到完全内皮化，而 PDL 组仅 19 例患者中有 5 例达到完全内皮化。
CCTA 可替代 TEE 检查内皮化状态，EIS 患者的内皮化率高于 PDL 患者。
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