Study About Relationship Between Left Atrial Appendage Morhpology And Thrombosis

Objective: To study the relationship between left atrial appendage morphology and left atrial appendage thrombosis in patients with atrial fibrillation.Methods: 71 patients with non-valvular atrial fibrillation who hospitalized in the Cardiovascular Dept.2 the Second Hospital of Hebei Medical University underwent radio frequency catheter ablation from March 2015 to March 2016,including 42 males,29 females,aged 31-78 years old.All patients were examined by transthoracic echocardiography,transesophageal echocardiography and 256-slice CT scan,and were divided into thrombus group and non-thrombus group according to the transesophageal echocardiography`s results.Record all patients` general condition,type of AF and CHA₂DS₂-VASc scores.Using transthoracic and transesophageal echocardiography to measure the left atrial diameter,the length of the left atrial appendage,the first turning angle of left atrial appendage from root to tip?the first curvature?,left atrial appendage leaf,left atrial appendage orifice width,the volume of the left atrial appendage,left atrial appendage ejection Fraction?LAA-EF?,left atrial appendage emptying velocity?LAA-EV?,left atrial appendage filling velocity?LAA-FV?,LVEF,E / e ',e' and other anatomical and functional indexes.Using spiral CT scan to clear the LAA`s morphology?refer Biase classification criteria?,understand the differences between thrombus group and non-thrombus group of left atrial appendage morphology and function indexes.Measurement data is expressed as mean ± standard deviation,comparison among groups in used in independent sample t test,count data is expressed as a percentage,differences between the two groups are compared using the ?2 test.Multivariate Logistic regression analysis is used to find the risk factors of left atrial appendage thrombosis.Taking transesophageal echocardiography as a standard to calculate the sensitivity,specificity,positive predictive value,negative predictive value of using 256-slice CT to diagnose the left atrial appendage thrombi,using Kappa test to detect the consistency.Results: The thrombus group includes 14 cases?19.7%?,57 patients?80.3%?in non-thrombus group.Comparisons between Two groups: gender,age,heart failure,hypertension,diabetes,stroke,coronary heart disease,CHA<sub>2</sub>DS<sub>2</sub>-VASc score,the first curvature,LVEF,E / e ',e' have no significant differences?P> 0.05?.9 cases?64.3%?with persistent atrial fibrillation in thrombus group,6 cases?10.5%?in non-thrombus group,were significantly different?P <0.05?.The thrombus group`s left atrium diameter are greater than non-thrombus group,left atrial appendage length and width of the orifice,the orifice area,left atrial appendage volume are greater than the non-thrombus group.The lobules of left atrial appendage are more than non-thrombus group,LAA-EV,LAA-FV,LAA-EF are less than non-thrombus group,the diffrences are statistically significant?P <0.05?.Compared to the non-thrombus group,LAA thrombus group has higher incidence of the Non-Chicken Wing shaped thrombosis,the result is statistically significant?P<0.05?.The type of atrial fibrillation,left atrial appendage ejection Fraction and LAA morphology are independent risk factors for left atrial appendage thrombosis?P<0.05?.Taking transesophageal echocardiography as the gold standard,256-slice CT detection of left atrial appendage thrombi sensitivity was 36%,specificity was 98%,positive predictive value was 83%,negative predictive value was 86%,chi-square test P value < 0.05,statistically significant,the Kappa test,Kappa value of 0.433,a lower consistency.Conclusions: Left atrial appendage morphology is related with left atrial appendage thrombosis in patients with atrial fibrillation,and the type of atrial fibrillation,left atrial appendage ejection Fraction,LAA morphology are independent risk factors for left atrial appendage thrombosis.256-slice CT and transesophageal echocardiography have low consistency in detecting left atrial appendage thrombus.