| Part one Correlation between left atrial appendage morphology and stroke risk in patients with atrial fibrillationObjective: Using 256-slice spiral CT to classify the left atrial app endage morphology,observe the left atrial appendage morphology,and q uantitatively evaluate the risk of stroke in patients with nonvalvular atria l fibrillation.Methods:Between September 2016 and November 2019,this study recruited 317 patients with atrial fibrillation who underwent coronary CTA scans in our hospital.There were 195 males and 122 females with an average age of 60.72 ± 10.63 years,including 45 patients with a history of stroke.The clinical data of each patient were recorded.The Philips EBW 4.5 workstation was used to reconstruct the original CTA image.The post-processing methods such as volume reconstruction(VR)and multi-planar reconstruction(MPR)were used to observe the left atrial appendage at different angles,and classify the morphology according to the left atrial appendage shape 7-type method [1],the "chicken-wing type" includes three subtypes of Type2 in this study,namely Type2a(Hand finger),Type2b(Paper fan),and Type2c(Wing).Statistical analysis was performed on the obtained data.Results:1.The group is according to the shape of left atrial appendage morphology like chicken wings(Type 2a、 Type 2b、 Type 2c)and non-chicken wings.After comparing each type of left atrial appendage,there were no significant differences in clinical data among groups,such as height,weight,BMI,and heart failure,diabetes,hypertension,vascular disease,CHA2DS2-VASc score,and type of atrial fibrillation(P> 0.05).2.Comparing the atrial fibrillation group with stroke and the group without stroke,the left atrial appendage morphology showed statistical differences in each group(P = 0.033);3.Type 2c is a protective factor for stroke(P = 0.011),there was no statistically significant difference in stroke risk between the chicken wings subtypes 2a,2b and non-wing type(P> 0.05).4.The older Patients have a higher risk of stroke(P = 0.000),but atrial fibrillation patients with lower CHA2DS2-VASc score are less likely to have a stroke(P= 0.000);The risk of stroke in patients with vascular disease was higher(P = 0.028).Conclusions:Using 256-slice spiral CT can objectively classify the left atrial appendage morphology.The left atrial appendage new classified method combines the atrial appendage morphology and apical orientation,which is more scientific than the chicken wing type in the four types.The new classification of left atrial appendage shape has certain clinical significance for predicting the risk of stroke,and provides new ideas for clinical prevention and treatment of stroke.Part two Quantitative study of relationship between left atrial appendage structure and stroke by 256-slice spiral CTObjective: 256-slice spiral CT was used to quantitatively measure the structure of the left atrial appendage,and evaluate its correlation with the risk of stroke in patients with nonvalvular atrial fibrillation,thus can further explore its clinical significance.Methods:This study selected 80 patients with AF from September 2016 to N ovember 2019,56 males and 24 females.The average age was about(65.64 ± 8.82)years old.Among them,40 patients had a history of strok e.According to age and gender matching,40 atrial fibrillation patients w ith no history of stroke were selected as the non-stroke group.The clinical data of each patient were recorded.All patients with atrial fibrillatio n underwent coronary CTA,and 75% phase images were used for postprocessing to obtain the left atrial appendage anatomical structure param eters of all patients : left atrial appendage volume(LAA),Left atrial a ppendage volume index(LAAVi),left atrial appendage orifice area,left atrial appendage orifice circumference,long diameter of the left atrial ap pendage orifice,short diameter of the left atrial appendage,left atrial a ppendage coronal angle.The data were statistically analyzed.Results:1.Adopt gender and age matching methods.General clinical data of AF group with stroke and non-stroke group: age,gender,height,weight,BSA and heart failure,diabetes,hypertension,vascular disease,CHA2DS2-VASc score,There was no significant difference between the two groups in factors such as the type of atrial fibrillation(P > 0.05).2.Compared with the atrial fibrillation patients with and without stroke,the left atrial appendage volume(LAAV),left atrial appendage volume index(LAAVi),left atrial appendage orifice area,long diameter of the left atrial appendage orifice,short diameter of the left atrial appendage were larger in the atrial fibrillation with stroke group than in the non-stroke group(P <0.05).3.The univariate logistic regression analysis affecting stroke showed that the left atrial appendage volume(LAAV),left atrial appendage volume index(LAAVi),left atrial appendage orifice area,Left atrial appendage orifice long axis and short axis increased,and the risk of stroke was higher.4.Analysis of the ROC curve of stroke showed that in atrial fibrillation patients if the left atrial appendage volume >8.7 ml,the highest value prediction of stroke risk in patients with atrial fibrillation(sensitivity 40.0%,specificity 90.0%).Conclusions:256-slice spiral CTA was used to quantitatively evaluate the left atrial appendage structure in patients with atrial fibrillation.The left atrial appendage volume,left atrial appendage volume index,left atrial appendage orifice area,Left atrial appendage orifice long axis and short axis get largerer,the risk of stroke is increased.ROC curve showed that when the left atrial appendage volume >8.7ml,the risk of stroke is increased than usual.This result has important clinical significance for clinically guiding anticoagulation therapy in patients with atrial fibrillation. |
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