心房颤动患者左心房纤维化定量诊断指标体系建立

Establishment of a quantitative diagnostic index system for left atrial fibrosis in patients with atrial fibrillation

摘要

目的 探讨延迟钎增强心脏磁共振（LGE-CMR）联合超声心动图参数、心外膜脂肪（EAT）计算机断层扫描 （CT）数据对心房颤动（AF）患者左心房纤维化程度的诊断价值，构建无创定量诊断指标体系。方法 纳入兰州大学第二医院心血管内科2023年3月—2024年3月经临床确诊的 AF 患者，采用 LGE-CMR 评估患者左心房纤维化程度，行二维斑点追踪超声心动图及CT检查获取超声参数、EAT数据。采用独立样本 t 检验、多因素Logistic等统计学方法结合受试者操作特征（ROC）曲线分析 AF 类型及各参数与左心房纤维化的关联及其诊断价值和最佳诊断界值。结果 持续性 AF 患者的左心房纤维化程度高于阵发性 AF 患者（P<0.05）；超声指标左心房储血期应变率峰值（pLASRr）诊断价值最高（AUC=0.903,P<0.001），其后依次为左心房最大容积（LAV）（AUC=0.829,P<0.001）、左心房最大容积指数（LAVI） （AUC =0.815, P<0.001）。结论 以pLASRr、LAV、LAVI为主要诊断指标，以左心房内径、左心室射血分数、左心室收缩末期内径、左心室舒张末期内径、左心房僵硬度指数、左心房储器阶段应变、左心房收缩期应变、左心房管道期应变、心房纵向应变峰值、左心耳开口径、左心耳峰值血流排空速度超声心动图参数及左心房心外膜脂肪体积为辅助诊断指标，建立的无创诊断体系可用于评估 AF 患者左心房纤维化程度。

Abstract

Objective To explore the analytical value of late gadolinium-enhanced cardiac magnetic resonance （LGE-CMR）combined with echocardiography parameters and epicardial adipose tissue（EAT）computed tomography（CT）data in assessing left atrial fibrosis severity in patients with atrial fibrillation（AF），and to establish a non-invasive and accurate quantitative diagnostic index system．Methods Patients diagnosed with AF in the Department of Cardiovascular Medicine，the Second Hospital of Lanzhou University from March 2023 to March 2024 were enrolled．LGE-CMR was used to evaluate the severity of left atrial fibrosis， while 2D-STE and CT were performed to obtain ultrasonic parameters and EAT data．Statistical methods such as independent samples t-test and multivariate Logistic regression，combined with receiver operating charac- teristic（ROC）curve，were applied to analyze the associations between AF types，various parameters and left atrial fibrosis，as well as the diagnostic value of these parameters for left atrial fibrosis and their optimal diagnostic cut-off values．Results The independent samples t-test showed that the severity of left atrial fibrosis in patients with persistent AF was significantly higher than that in patients with paroxysmal AF ．Multivariate Logistic regression combined with ROC curve analysis revealed that the ultrasonic index peak left atrial strain rate during reservoir phase（pLASRr）had the highest diagnostic value（AUC=0.903,P<0.001），followed by left atrial maximal volume（LAV）（AUC =0.829,P<0.001）and left atrial maximal volume index（LAVI） （AUC =0.815,P<0.001）．Conclusion The non-invasive diagnostic system，established with pLASRr，LAV， and LAVI as the main diagnostic indicators，and echocardiographic parameters including left atrial diameter （LAD），left ventricular ejection fraction（LVEF），left ventricular end-systolic diameter（LVDs），left ventricular end-diastolic diameter（LVDd），left atrial stiffness index（LASI），left atrial reservoir strain（LASr），left atrial contraction strain（LASct），left atrial conduit strain（LAScd），peak atrial longitudinal strain（PALS），left atrial appendage diameter（LAA-D），left atrial appendage peak emptying velocity（LAA-PEV），and left atrial epicar- dial adipose tissue volume（LA-EAT）as auxiliary diagnostic indicators，can be used to assess the degree of left atrial fibrosis in patients with atrial fibrillation AF ．

关键词

心房颤动 / 左心房纤维化 / 超声心动图 / 计算机断层扫描 / 延迟钎增强心脏磁共振

Key words

atrial fibrillation / left atrial fibrosis / echocardiography / computed tomography / delayed gadolini- um-enhanced cardiac magnetic resonance

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基金资助

甘肃省科技计划项目-重点研发计划资助项目(25YFFA053)

兰州大学第二医院萃英科技创新计划应用基础资助项目(CY20 23-MS-B06)

兰州大学第二医院＂萃英学子科研培育＂计划资助项目(CYXZ2024-38)