Relationship among left atrial appendage structure,hemodynamics and left atrial appendage thrombosis reviewed by computed tomography angiography in patients with non-valvular atrial fibrillation

Li Xuan; Hu Pengtao; Liu Junlan

doi:10.3969/j.issn.1674-4055.2024.10.15

Abstract：Objective To investigate the relationship among left atrial appendage structure,hemodynamics and left atrial appendage thrombosis(LAAT)reviewed by computed tomography angiography(CTA)in patients with non-valvular atrial fibrillation(NVAF).Methods NVAF patients(n=180)were chosen from Central Hospital of Tangshan City from Jan.2020 to Dec.2021,and all patients were given examinations of CTA and transesophageal echocardiography(TEE).Taken TEE detection results as gold standard,the consistency between CTA and TEE was reviewed by using Kappa test.The patients were divided,according to whether they had thrombosis or not,into thrombosis group(n=36)and non-thrombosis group(n=144),and clinical materials were collected from all patients.The relationship among parameters of left atrial appendage(LAA),hemodynamics and thrombosis was analyzed by using multi-factor Logistics regression analysis.The dose-response relationship between LAA parameters and thrombosis risk was estimated by using spline function method combined with Logistics regression.Results There were 36 LAAT cases detected(20.00％)by TEE,and taken this result as standard,there were 33 LAAT cases detected by CTA,and detection rate was 91.67％,missed diagnosis rate was 13.89％,and misdiagnosis rate was 1.39％.The diagnostic results of TEE and CTA were highly consistent(Kappa=0.836).The cases of heart failure(HF)were less,and level of N-terminal pro-brain natriuretic peptide(NT-proBNP),CHA2DS2-VASc scores and levels of D-dimer(D-D)and serum uric acid(SUA)were lower in non-thrombosis group than those in thrombosis group(P＜0.05).The short diameter of LAA opening,long diameter of LAA opening,LAA opening area,LAA volume,left atrial volume,long diameter of left upper pulmonary vein opening,left ventricular end-diastolic diameter(LVEDd)and left atrial diameter(LAD)were higher,and left ventricular ejection fraction(LVEF)and left atrial appendage flow velocity(LAAV)were lower in non-thrombosis group than those in thrombosis group(P＜0.05).The results of multi-factor Logistics regression analysis showed that short diameter of LAA opening,long diameter of LAA opening,LAA opening area,LAA volume,left atrial volume,long diameter of left upper pulmonary vein opening and LAA spatial morphology were negatively correlated to LVEF and LAAV(β＜1,P＜0.05),and positively correlated to LVEDd and left ventricular end-systolic diameter(LVESd,β＞1,P＜0.05).There was a significant positive correlation among short diameter of LAA opening(OR=1.757,9 5％CI:1.239～1.971,P＜0.001),long diameter of LAA opening(OR=1.912,95％CI:1.348～2.019,P＜0.001),LAA opening area(OR=1.843,95％CI:1.275～1.920,P＜0.001),LAA volume(OR=1.768,95％CI:1.423～1.991,P＜0.001),left atrial volume(OR=1.876,95％CI:1.335～1.989,P＜0.001),long diameter of left upper pulmonary vein opening(OR=1.732,95％CI:1.209～1.887,P＜0.001),cauliflower type of LAA spatial morphology(OR=1.790,95％CI:1.392～1.954,P＜0.001)and thrombosis.The risk of thrombosis increased with the increases of short diameter of LAA opening,long diameter of LAA opening,LAA opening area,LAA volume,left atrial volume and long diameter of left upper pulmonary vein opening.Conclusion The short diameter of LAA opening,long diameter of LAA opening,LAA opening area,LAA volume,left atrial volume,long diameter of left upper pulmonary vein opening and LAA spatial morphology are negatively correlated to LVEF and LAAV,and positively correlated to LVEDd and LVESd,and they are significantly correlated to thrombosis.