Ouchi Kotaro, Sakuma Toru, Kisaki Shunsuke, Tokutake Kenichi, Tokuda Michifumi, Yamane Teiichi, Ojiri Hiroya
Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan.
Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan.
Eur Radiol. 2025 Aug 8. doi: 10.1007/s00330-025-11856-y.
Early filling defects in the left atrial appendage (LAA), observed during the early phase of cardiac computed tomography (CT), are associated with increased risks of stroke and cardiovascular events. This study aims to evaluate the relationships between left atrial volume (LAV), left atrial appendage volume (LAAV), and the LAA orifice area, as well as identify factors associated with early LAA filling defects in atrial fibrillation (AF) patients, using optimized cardiac phases in multiphase CT imaging.
This retrospective study analyzed 562 patients with AF who underwent cardiac CT before pulmonary vein isolation (PVI). Relationships between LAV, LAAV, and LAA orifice area were assessed using Pearson's rank correlation coefficients. Factors associated with early LAA filling defects were evaluated using multivariate logistic regression. Receiver operating characteristic analysis was performed to determine the threshold value predictive of these defects. The impact of PVI on defect resolution was also assessed.
Left atrial volume index (LAVI) was significantly correlated with LAAV index (ρ = 0.59, p < 0.001) and LAA orifice area index (ρ = 0.66, p < 0.001). Maximum LAVI was independently associated with early LAA filling defects (p < 0.001), with a threshold of 78.5 cm³/m² yielding 81.9% sensitivity and 77.6% specificity. Among 49 patients with initial defects, 27 underwent follow-up CT after PVI, and 88.9% showed resolution accompanied by significant LAV reductions.
The maximum LAVI is a critical factor associated with LAA early filling defects, with reductions in LAV after PVI leading to defect resolution.
Question What factors are associated with early left atrial appendage (LAA) filling defects, and do these defects resolve following pulmonary vein isolation (PVI)? Findings A left atrial volume index (LAVI) threshold of 78.5 cm³/m² is associated with early LAA filling defects, which resolve after PVI-induced reductions in LAVI. Clinical relevance Identifying the association between LAVI and early LAA filling defects may improve risk stratification for cardiovascular and thromboembolic events in patients with atrial fibrillation. PVI-induced reductions in LAVI could contribute to a decrease in the risk of such events.
在心脏计算机断层扫描（CT）早期观察到的左心耳（LAA）早期充盈缺损与中风和心血管事件风险增加相关。本研究旨在利用多期CT成像中的优化心脏期相，评估左心房容积（LAV）、左心耳容积（LAAV）和LAA开口面积之间的关系，并确定心房颤动（AF）患者中与LAA早期充盈缺损相关的因素。
这项回顾性研究分析了562例在肺静脉隔离（PVI）前接受心脏CT检查的AF患者。使用Pearson等级相关系数评估LAV、LAAV和LAA开口面积之间的关系。使用多因素逻辑回归评估与LAA早期充盈缺损相关的因素。进行受试者工作特征分析以确定预测这些缺损的阈值。还评估了PVI对缺损消退的影响。
左心房容积指数（LAVI）与LAAV指数显著相关（ρ = 0.59，p < 0.001）以及与LAA开口面积指数显著相关（ρ = 0.66，p < 0.001）。最大LAVI与LAA早期充盈缺损独立相关（p < 0.001），阈值为78.5 cm³/m²时，敏感性为81.9%，特异性为77.6%。在49例初始有缺损的患者中，27例在PVI后接受了随访CT检查，88.9%的患者显示缺损消退，同时LAV显著降低。
最大LAVI是与LAA早期充盈缺损相关的关键因素，PVI后LAV降低导致缺损消退。
问题 哪些因素与左心耳（LAA）早期充盈缺损相关，这些缺损在肺静脉隔离（PVI）后是否消退？ 发现 左心房容积指数（LAVI）阈值为78.5 cm³/m²与LAA早期充盈缺损相关，这些缺损在PVI导致LAVI降低后消退。 临床意义 确定LAVI与LAA早期充盈缺损之间的关联可能改善心房颤动患者心血管和血栓栓塞事件的风险分层。PVI导致的LAVI降低可能有助于降低此类事件的风险。
