标题：经食管实时三维超声心动图指标与房颤患者左心耳血栓发生的关系

      作者：白炜，康楠，李昱茜，曹亮，孟欣    空军军医大学第一附属医院超声医学科，陕西 西安 710032

      卷次： 2022年33卷21期

      【摘要】 目的 分析房颤患者经食管实时三维超声心动图(RT-3DTEE)指标与左心耳血栓发生的关系及诊断价值。方法 选取2017年1月至2020年12月空军军医大学第一附属医院收治的89例房颤患者为研究对象，根据是否合并左心耳血栓分为无血栓组 58例和血栓组 31例，所有患者均接受 RT-3DTEE检查，比较两组患者的RT-3DTEE指标[左心耳开口面积(LAA-O)、左心耳长径(LAA-L)、左房容积(LA-V)、左心耳容积(LAA-V)、左心耳排空血流速度(LAA-v)、左心耳射血分数(LAA-EF)]，采用Pearson检验分析房颤患者RT-3DTEE指标间的相关性，采用受试者工作特征曲线(ROC)分析其对左心耳血栓的诊断价值，采用Logistic回归分析影响左心耳血栓发生的危险因素。结果 血栓组患者的LAA-O、LAA-L、LA-V、LAA-V值大于无血栓组，LAA-v、LAA-EF值小于无血栓组，差异均有统计学意义(P<0.05)；经 Pearson检验分析结果显示，LAA-O、LA-V值与 LAA-v、LAA-EF值呈负相关(P<0.05)；RT-3DTEE指标联合检查的ROC曲线下面积(AUC)大于各指标单独检测，差异均有统计学意义(P<0.05)；血栓组患者在LAA-O≥3.95 cm2、LAA-L≥22.38 mm、LAA-V≥8.59 mL、LAA-v<26.31 cm/s、LAA-EF<28.73%方面的人数比例明显高于无血栓组，差异均有统计学意义(P<0.05)；经Logistic回归分析结果显示，LLAA-V≥8.59 mL、LAA-v≥26.31 cm/s是影响左心耳血栓发生的危险因素(P<0.05)。结论 LAA-V≥8.59 mL、LAA-v≥26.31 cm/s是影响左心耳血栓发生的危险因素，且RT-3DTEE指标联合检查对房颤患者左心耳血栓具有诊断价值。
      【关键词】 心房颤动；经食管实时三维超声心动图；左心耳血栓；诊断价值；准确度
      【中图分类号】 R541.7+5 【文献标识码】 A 【文章编号】 1003—6350（2022）21—2811—04

Relationship between real-time three-dimensional transesophageal echocardiography indexes and left atrialappendage thrombosis in patients with atrial fibrillation.
BAI Wei, KANG Nan, LI Yu-qian, CAO Liang, MENG Xin.Department of Ultrasound Medicine, the First Affiliated Hospital of Air Force Military Medical University, Xi'an 710032,Shaanxi, CHINA
【Abstract】 Objective To analyze the relationship between real-time three-dimensional transesophageal echo-cardiography (RT-3DTEE) indexes and left atrial appendage thrombus (LAAT), and its diagnostic value in patients withatrial fibrillation. Methods Eighty-nine patients with atrial fibrillation admitted to the First Affiliated Hospital of AirForce Military Medical University were enrolled as the research objects between January 2017 and December 2020. Ac-cording to presence or absence of LAAT, they were divided into non-thrombus group (n=58) and thrombus group (n=31). All patients underwent RT-3DTEE examination. RT-3DTEE indexes [open area of left atrial appendage (LAA-O),length of left atrial appendage (LAA-L), left atrial volume (LA-V), left atrial appendage volume (LAA-V), empty bloodflow velocity of left atrial appendage (LAA-v), left atrial appendage ejection fraction (LAA-EF)] were compared be-tween the two groups. The correlation of RT-3DTEE indexes was analyzed by Pearson test, and their diagnostic value forLAAT was analyzed by receiver operating characteristic (ROC) curves. Risk factors of LAAT was analyzed by Logistic re-gression analysis. Results LAA-O, LAA-L, LA-V, and LAA-V values in the thrombus group were greater than those inthe non-thrombus group, while LAA-v and LAA-EF values were lower than those in non-thrombus group, and the differ-ences were statistically significant (P<0.05). The results of Pearson test showed that LAA-O and LA-V values were nega-tively correlated with LAA-v and LAA-EF (P<0.05). The area under ROC curve (AUC) of combined detection with allRT-3DTEE indexes was greater than that of single index, with statistically significant differences (P<0.05). The propor-tions of patients with LAA-O≥3.95 cm2, LAA-L≥22.38 mm, LAA-V≥8.59 mL, LAA-v<26.31 cm/s, and LAA-EF<28.73% in the thrombus group were significantly higher than those in non-thrombus group, with statistically significant dif-ferences (P<0.05). The results of Logistic regression analysis showed that LAA-V≥8.59 mL and LAA-v≥26.31 cm/s,were risk factors of LAAT (P<0.05). Conclusion LAA-V≥8.59 mL and LAA-v≥26.31 cm/s are risk factors ofLAAT. The combined detection of RT-3DTEE indexes has diagnostic value for LAAT in patients with atrial fibrillation.
      【Key words】 Atrial fibrillation; Real-time three-dimensional transesophageal echocardiography; Left atrial ap-pendage thrombus; Diagnostic value; Accuracy