Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China.
GE Healthcare, Computed Tomography Research Center, Beijing, China.
Clin Imaging. 2024 Oct;114:110247. doi: 10.1016/j.clinimag.2024.110247. Epub 2024 Jul 30.
To assess the anatomical complexity of the left atrial appendage (LAA) using fractal dimension (FD) based on cardiac computed tomography angiography (CTA) and the association between LAA FD and LAA thrombosis.
Patients with atrial fibrillation (AF) who underwent both cardiac CTA and transesophageal echocardiography (TEE) between December 2018 and December 2022 were retrospectively analyzed. Patients were categorized into normal (n = 925), circulatory stasis (n = 82), and thrombus groups (n = 76) based on TEE results and propensity score matching (PSM) was performed for subsequent analysis. FD was calculated to quantify the morphological heterogeneity of LAA. Independent risk factors for thrombus were screened using logistic regression. The diagnostic performance of FD and CHADS-VaSc score for predicting thrombus was evaluated using the area under the receiver operating characteristics curve (AUC).
LAA FD was higher in the thrombus group (1.61 [1.49, 1.70], P < 0.001) than in the circulatory stasis (1.33 [1.18, 1.47]) and normal groups (1.30 [1.18, 1.42]) both before and after PSM. LAA FD was also an independent risk factor in the thrombus (OR [odds ratio] = 570,861.15 compared to normal, 41,122.87 compared to circulatory stasis; all P < 0.001) and circulatory stasis group (OR = 98.87, P = 0.001) after PSM. The diagnostic performance of LAA FD was significantly better than the CHADS-VaSc score in identifying thrombus.
Patients with high LAA FD are more likely to develop LAA thrombus, and the use of FD provides an effective method for assessing the risk of thrombosis in AF patients, thereby guiding individualized clinical treatment.
利用基于心脏计算机断层血管造影（CTA）的分形维数（FD）评估左心耳（LAA）的解剖复杂性，并探讨 LAA FD 与 LAA 血栓之间的关系。
回顾性分析 2018 年 12 月至 2022 年 12 月间同时接受心脏 CTA 和经食管超声心动图（TEE）检查的房颤患者。根据 TEE 结果将患者分为正常组（n=925）、循环淤滞组（n=82）和血栓组（n=76），并进行倾向评分匹配（PSM）后进行后续分析。计算 FD 以量化 LAA 的形态异质性。使用 logistic 回归筛选血栓形成的独立危险因素。使用受试者工作特征曲线（ROC）下面积（AUC）评估 FD 和 CHADS-VaSc 评分预测血栓的诊断性能。
血栓组的 LAA FD 高于循环淤滞组（1.61[1.49，1.70]，P<0.001）和正常组（1.30[1.18，1.42]），无论是否进行 PSM。LAA FD 也是血栓组（OR[比值比]=570,861.15 与正常组相比，41,122.87 与循环淤滞组相比；均 P<0.001）和循环淤滞组（OR=98.87，P=0.001）的独立危险因素，无论是否进行 PSM。LAA FD 在诊断血栓方面的性能明显优于 CHADS-VaSc 评分。
LAA FD 较高的患者更有可能发生 LAA 血栓形成，FD 的使用为评估房颤患者血栓形成风险提供了一种有效的方法，从而指导个体化的临床治疗。
