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中华心脏与心律电子杂志 ›› 2022, Vol. 10 ›› Issue (01) : 18 -22. doi: 10.3877/cma.j.issn.2095-6568.2022.01.005

所属专题: 总编推荐

临床研究

心脏增强CT评估左心耳封堵术后装置内皮化的研究
赵铭哲1, 莫斌峰1, 孙健1, 张澎湃1, 李威1, 张睿1, 陈牧1, 池润民1, 王群山1,(), 李毅刚1   
  1. 1. 200092 上海,上海交通大学医学院附属新华医院心血管内科
  • 收稿日期:2022-02-09 出版日期:2022-03-25
  • 通信作者: 王群山
  • 基金资助:
    国家自然科学基金重大研究计划培育项目(91949128); 国家自然科学基金面上项目(81873485); 广东省钟南山医学基金会科研项目(ZNSA-2020017-8)

The value of cardiac computed tomography in assessing device endothelialization after left atrial appendage closure

Mingzhe Zhao1, Binfeng Mo1, Jian Sun1, Pengpai Zhang1, Wei Li1, Rui Zhang1, Mu Chen1, Runmin Chi1, Qunshan Wang1,(), Yigang Li1   

  1. 1. Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092, China
  • Received:2022-02-09 Published:2022-03-25
  • Corresponding author: Qunshan Wang
引用本文:

赵铭哲, 莫斌峰, 孙健, 张澎湃, 李威, 张睿, 陈牧, 池润民, 王群山, 李毅刚. 心脏增强CT评估左心耳封堵术后装置内皮化的研究[J/OL]. 中华心脏与心律电子杂志, 2022, 10(01): 18-22.

Mingzhe Zhao, Binfeng Mo, Jian Sun, Pengpai Zhang, Wei Li, Rui Zhang, Mu Chen, Runmin Chi, Qunshan Wang, Yigang Li. The value of cardiac computed tomography in assessing device endothelialization after left atrial appendage closure[J/OL]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2022, 10(01): 18-22.

目的

利用心脏增强CT评估左心耳封堵(Watchman,美国波士顿科学公司)术后装置的内皮化。

方法

本研究为单中心回顾性研究,连续入选2017年3月至2021年7月在上海交通大学医学院附属新华医院收治的的非瓣膜性心房颤动患者,进行左心耳封堵手术治疗,术后6个月应用心脏增强CT评估装置内皮化程度。

结果

研究纳入64例患者,年龄(74.8±8.4)岁,其中男42例(65.6%,42/64),女22例(34.4%,22/64)。所有患者均成功植入左心耳封堵装置,术后6个月心脏增强CT显示,40例(62.5%,40/64)患者封堵装置完全内皮化(内皮化组),24例(37.5%,24/64)患者装置不完全内皮化(不完全内皮化组)。完全内皮化组的总胆固醇[(3.91±1.00)mmol/L对(3.40±0.73)mmol/L,P=0.036)]、甘油三酯[(1.44±0.74)mmol/L对(1.02±0.45)mmol/L,P=0.009]、低密度脂蛋白[(2.19±0.86)mmol/L对(1.68±0.51)mmol/L,P=0.005]水平均明显高于不完全内皮化组,差异具有统计学意义。

结论

利用心脏增强CT可评估左心耳封堵术后内皮化。

Objective

This study aimed to evaluate endothelialization of left atrial appendage closure(LAAC) device (Watchman, Boston Scientific Corporation, USA)by cardiac computed tomography(CCT).

Methods

This was a single center retrospective study. Patients with non-valvular atrial fibrillation who underwent Watchman left atrial appendage closure were consecutively enrolled. Cardiac CT was used to evaluate the endothelialization degree of Watchman device at 6-month follow-up post procedure.

Results

A total of 64 patients were included. The age was (74.8±8.4) years old, and 22(34.4%, 22/64) of them were female. Watchman device was successfully implanted in each patient. At 6-month follow-up, complete endothelialization were detected in 40 patients (62.5%, 40/64), while incomplete endothelialization were detected in 24 patients (37.5%, 24/64). The levels of cholesterol [(3.91±1.00) mmol/L vs. (3.40±0.73) mmol/L,P=0.036], triglyceride [(1.44±0.74) mmol/L vs. (1.02±0.45) mmol/L,P=0.009] and low density lipoprotein [(2.19±0.86) mmol/L vs. (1.68±0.51) mmol/L,P=0.005] was higher in complete endothelialized group, than that of in incomplete endothelialized groups.

Conclusion

It is feasible to evaluate the degree of endothelialization of Watchman device post LAAC by CCT.

表1 64例行左心耳封堵术心房颤动患者基线特征
[1]
周自强, 胡大一, 陈捷, 等. 中国心房颤动现状的流行病学研究[J].中华内科杂志, 2004, 43(7):491-494.
[2]
Holmes DR, Reddy VY, Turi ZG, et al. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial[J]. Lancet, 2009, 374(9689):534-542.
[3]
Reddy VY, Doshi SK, Sievert H, et al. Percutaneous left atrial appendage closure for stroke prophylaxis in patients with atrial fibrillation: 2.3-Year Follow-up of the PROTECT AF (Watchman Left Atrial Appendage System for Embolic Protection in Patients with Atrial Fibrillation) Trial[J]. Circulation, 2013, 127(6):720-729..
[4]
Holmes DRJr, Kar S, Price MJ, et al. Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial[J]. J Am Coll Cardiol, 2014, 64(1):1-12.
[5]
Saw J, Fahmy P, DeJong P, et al. Cardiac CT angiography for device surveillance after endovascular left atrial appendage closure[J]. Eur Heart J Cardiovasc Imaging, 2015, 16(11):1198-1206.
[6]
Prakash R, Saw J. Imaging for percutaneous left atrial appendage closure[J]. Catheter Cardiovasc Interv, 2018, 92(2):437-450..
[7]
Zhao MZ, Chi RM, Yu Y, et al. Value of detecting peri-device leak and incomplete endothelialization by cardiac CT angiography in atrial fibrillation patients post Watchman LAAC combined with radiofrequency ablation[J]. J Cardiovasc Electrophysiol, 2021, 32(10):2655-2664.
[8]
王群山, 莫斌峰, 孙健, 等. 导管消融联合左心耳封堵一站式治疗心房颤动的临床应用[J]. 中华心律失常学杂志, 2021, 25(6):498-503.
[9]
王群山, 陈牧, 孙健, 等. 心房颤动导管消融联合左心耳封堵一站式手术的可行性和围术期安全性分析[J]. 中华心血管病杂志, 2020, 48(10):842-847.
[10]
Qamar SR, Jalal S, Nicolaou S, et al. Comparison of cardiac computed tomography angiography and transoesophageal echocardiography for device surveillance after left atrial appendage closure[J]. EuroIntervention, 2019, 15(8):663-670.
[11]
Mo BF, Wan Y, Alimu A, et al. Image fusion of integrating fluoroscopy into 3D computed tomography in guidance of left atrial appendage closure[J]. Eur Heart J Cardiovasc Imaging, 2021, 22(1):92-101.
[12]
Ismail TF, Panikker S, Markides V, et al. CT imaging for left atrial appendage closure: a review and pictorial essay[J]. J Cardiovasc Comput Tomogr, 2015, 9(2):89-102.
[13]
Schwartz RS, Holmes DR, Van Tassel RA, et al. Left atrial appendage obliteration: mechanisms of healing and intracardiac integration[J]. JACC Cardiovasc Interv, 2010, 3(8):870-877.
[14]
Sivasambu B, Arbab-Zadeh A, Hays A, et al. Delayed endothelialization of watchman device identified with cardiac CT[J]. J Cardiovasc Electrophysiol, 2019, 30(8):1319-1324.
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