| Background and Objective Thromboembolism is the most popularcomplication of atrial fibrillation (AF) which is the most common sustained arrhythmia. Non-valvular atrial fibrillation (NVAF) accounts for 87% among all of AF. The patients with NVAF will add to quintuple risk of stroke than the patients without NVAF, Anticoagulant therapy can obviously reduce the stroke incidence of the patients with NVAF,that have been demonstrated by the results of large scale clinic random trials. Because of anticoagulant therapy adding to bleeding risk meanwhile reducing the complication of thromboembolism, it appears especially important to prevent thromboembolism by evaluating the risk of embolism, screening high-risk patients. The previous studies showed some risk factors in thromboembolism, such as clinical risk factors, echocardiography index, blood thrombosis marker and fibrillatory wave feature. Recently, multislice computed tomography scanning technique have been becoming a better detection means. In the present study, we intend to evaluate the clinical value of 64-slices spiral CT for the detection of left atrial thrombi in patients with NVAF by comparing 64-slices spiral CT results with transesophageal echocardiography (TEE) results. It can provide evidence for anticoagulant therapy by screening high-risk patients who are analyzed combining echocardiography index and fibrillatory wave feature.Patients and Methods 64-slices spiral CT were performed in 41 patients with NVAF. 64-slices spiral CT and TEE were performed in 19 patients with NVAF in a week,Then these 41 patients were classified into thrombus group(n=6), prothrombotic-state group (n=7) and non-thrombus group (n=28) according to the results of 64-slices spiral CT. All patients underwent transthoracic echocardiography to detect LAD, LVEDD and LVEF. A standard ECG in V1 lead was recorded at a special speed (50mm/s) and sensitivity (lmV/20mm).Results(1) The control study result: 1) There were no significant differences in sex, age ,AF duration, heart rate and underlying diseases between 41 patients who were performed by 64-slices spiral CT and 19 patients who were performed by 64-slices spiral CT and TEE. (P>0.05). 2) 64-slices spiral CT were performed in 41 patients with NVAF, Both 64-slices spiral CT and TEE were performed in 19 out of 41 patients with NVAF. 64-slices spiral CT detected left atrial thrombi in 6 patients, in 2 of these patients, left atrial thrombi were demonstrated by TEE; 64-slices spiral CT detected prothrombotic-state of left atrial in 7 of 41 patients, in 3 of these patients, left atrial spontaneous echo contrast (LASEC) was noted in TEE;64-slices spiral CT ruled out the presence of thrombus in 28 patients, in 14 of these patients without left atrial thrombi in TEE.(2) There were no significant differences in sex, age, AF duration, heart rate and underlying diseases between thrombus group(n=6), prothrombotic-state group(n=7) and non- thrombus group(n=28) (P>0.05).(3) The incidence of fine AF in the thrombus group and prothrombitic-state group is higher than that in non- thrombus group (83% vs 71% vs 54%). but there were no significant differences in this three groups (P>0.05).(4) The amplitude of fibrillatory wave was significantly smaller in the thrombus group than that in non-thrombus group (0.061±0.040 vs 0.099±0.036mV, P<0.05); The amplitude of fibrillatory wave was a little smaller in the prothrombotic-state group than that in non-thrombus group (0.090±0.045vs 0.099±0.036mV, P>0.05); The amplitude of fibrillatory wave was smaller in the thrombus group than that in the prothrombotic-state group (0.061±0.040 vs 0.090±0.045mV, P>0.05) .(5) LAD was significantly larger in the thrombus group than that in non- thrombus group(49.5±5.5 vs41.6±5.5mm,P<0.05); LAD was larger in the prothrombotic-state group than that in non-thrombus group(48.0±9.1vs41.6±5.5mm, P<0.05); LAD was a little larger in the thrombus group than that in the prothrombotic-state group (49.5±5.5vs48.0±9.1mm, P>0.05) . There were no significant differences in LVEDD and LVEF in this three groups (P>0.05).Conclusions(1) left atrial thrombi can be demonstrated by 64-slices spiral CT when filling defect exists in both prophase and advanced stage scanning. prothrombotic-state can be diagnosed by 64-slices spiral CT when filling defect exists in prophase scanning and vanishs in advanced stage scanning.(2) TEE may not be feasible in certain situations and 64-slices spiral CT may be used as a reliable alternative for the detection of left atrial thrombi.(3) The incidence of fine AF in the thrombus group is significant higher than that in non- thrombus group. The amplitude of fibrillatory wave was significantly smaller in the thrombus group than that in non- thrombus group. So the amplitude of fibrillatory could conduce to predict the risk of thromboembolism.(4) LAD was significantly larger in the thrombus group than that in non- thrombus group, LAD has some significance in estimating the risk of thromboembolism. |
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