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Left atrial appendage orifice area and morphology is closely associated with flow velocity in patients with nonvalvular atrial fibrillation
BMC Cardiovascular Disorders ( IF 2.1 ) Pub Date : 2021-09-16 , DOI: 10.1186/s12872-021-02242-9
Lei Chen 1 , Changjiang Xu 2 , Wensu Chen 1 , Chaoqun Zhang 1
Affiliation  

Thromboembolic events are the most serious complication of atrial fibrillation (AF), and the left atrial appendage (LAA) is the most important site of thrombosis in patients with AF. During the period of COVID-19, a non-invasive left atrial appendage detection method is particularly important in order to reduce the exposure of the virus. This study used CT three-dimensional reconstruction methods to explore the relationship between LAA morphology, LAA orifice area and its mechanical function in patients with non-valvular atrial fibrillation (NVAF). A total of 81 consecutive patients with NVAF (36 cases of paroxysmal atrial fibrillation and 45 cases of persistent atrial fibrillation) who were planned to undergo catheter radiofrequency ablation were enrolled. All patients were examined by transthoracic echocardiography (TTE), TEE, and computed tomography angiography (CTA) before surgery. The LAA orifice area was obtained according to the images of CTA. According to the left atrial appendage morphology, it was divided into chicken wing type and non-chicken wing type. At the same time, TEE was performed to determine left atrial appendage flow velocity (LAAFV), and the relationship between the left atrial appendage orifice area and LAAFV was analyzed. The LAAFV in Non-chicken wing group was lower than that in Chicken wing group (36.2 ± 15.0 cm/s vs. 49.1 ± 22.0 cm/s, p-value < 0.05). In the subgroup analysis, the LAAFV in Non-chicken wing group was lower than that in Chicken wing group in the paroxysmal AF (44.0 ± 14.3 cm/s vs. 60.2 ± 22.8 cm/s, p-value < 0.05). In the persistent AF, similar results were observed (29.7 ± 12.4 cm/s vs. 40.8 ± 17.7 cm/s, p-value < 0.05). The LAAFV in persistent AF group was lower than that in paroxysmal AF group (34.6 ± 15.8 cm/s vs. 49.9 ± 20.0 cm/s, p-value < 0.001). The LAAFV was negatively correlated with left atrial dimension (R = − 0.451, p-value < 0.001), LAA orifice area (R= − 0.438, p-value < 0.001) and left ventricular mass index (LVMI) (R= − 0.624, p-value < 0.001), while it was positively correlated with LVEF (R = 0.271, p-value = 0.014). Multiple linear regression analysis showed that LAA morphology (β = − 0.335, p-value < 0.001), LAA orifice area (β = − 0.185, p-value = 0.033), AF type (β = − 0.167, p-value = 0.043) and LVMI (β = − 0.465, p-value < 0.001) were independent factors of LAAFV. The LAA orifice area is closely related to the mechanical function of the LAA in patients with NVAF. The larger LAA orifice area and LVMI, Non-chicken wing LAA and persistent AF are independent predictors of decreased mechanical function of LAA, and these parameters might be helpful for better management of LA thrombosis.

中文翻译:

非瓣膜性房颤患者左心耳口面积及形态与血流速度密切相关

血栓栓塞事件是房颤(AF)最严重的并发症,而左心耳(LAA)是房颤患者最重要的血栓形成部位。在COVID-19期间,为了减少病毒的暴露,一种无创的左心耳检测方法尤为重要。本研究采用CT三维重建方法探讨非瓣膜性心房颤动(NVAF)患者左心耳形态、左心耳口面积与其力学功能的关系。共纳入 81 例计划接受导管射频消融的连续 NVAF 患者(阵发性房颤 36 例,持续性房颤 45 例)。所有患者均通过经胸超声心动图 (TTE)、TEE、和计算机断层扫描血管造影 (CTA) 术前。根据 CTA 图像获得 LAA 孔口面积。根据左心耳形态,分为鸡翅型和非鸡翅型。同时行TEE测定左心耳流速(LAAFV),分析左心耳口面积与LAAFV的关系。非鸡翅组的 LAAFV 低于鸡翅组(36.2 ± 15.0 cm/s vs. 49.1 ± 22.0 cm/s,p 值 < 0.05)。在亚组分析中,非鸡翅组的 LAAFV 在阵发性 AF 中低于鸡翅组(44.0 ± 14.3 cm/s vs. 60.2 ± 22.8 cm/s,p 值 < 0.05)。在持续性 AF 中,观察到类似的结果(29.7 ± 12.4 cm/s vs. 40.8 ± 17.7 cm/s,p 值 < 0。05)。持续性 AF 组的 LAAFV 低于阵发性 AF 组(34.6 ± 15.8 cm/s vs. 49.9 ± 20.0 cm/s,p 值 < 0.001)。LAAFV 与左心房尺寸(R = - 0.451,p 值 < 0.001)、LAA 口面积(R = - 0.438,p 值 < 0.001)和左心室质量指数(LVMI)(R = - 0.624)呈负相关, p 值 < 0.001),而它与 LVEF 呈正相关(R = 0.271,p 值 = 0.014)。多元线性回归分析显示左心耳形态(β=-0.335,p值<0.001),左心耳孔口面积(β=-0.185,p值=0.033),房颤类型(β=-0.167,p值=0.043 ) 和 LVMI (β = − 0.465, p 值 < 0.001) 是 LAAFV 的独立因素。左心耳口面积与 NVAF 患者左心耳的机械功能密切相关。较大的 LAA 孔口面积和 LVMI,
更新日期:2021-09-16
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