cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2023.6.n2453cardio-2453Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИRESEARCH ARTICLESКомпьютерная томография в положении лежа на левом боку перед катетерной аблацией у больных с мерцательной аритмиейLeft lateral decubitus computed tomography before catheter ablation in patients with atrial fibrillationhttps://orcid.org/0000-0003-4825-749XКалиевБауыржанKaliyevBauyrzhan Bakhytovich

врач лучевой диагностики отделения радиологии НАО «Национальный научный кардиохирургический центр»

Республика Казахстан

Doctor of computed tomography at radiology department of National research cardiac surgery center

Kazakhstan

baur233113@mail.ruhttps://orcid.org/0000-0002-3490-6324РахимжановаРаушан ИбжановнаRakhimzhanovaRaushan Ibzhanovna

заведующая кафедрой радиологии №1 АО «Медицинский университет Астана»

Республика Казахстан

Head of the Department of Radiology No. 1 of JSC "Astana Medical University", Chief Specialist in Radiology field of the Ministry of Health of the Republic of Kazakhstan, Honored Worker of the Republic of Kazakhstan, Academician of the Academy of Preventive Medicine of the Republic of Kazakhstan

Astana, Kazakhstan

rakhimzhanova01@rambler.ruhttps://orcid.org/0000-0002-5649-2193СиницынВалентин ЕвгеньевичSinitsynValentin Evgenyevich

руководитель курса лучевой диагностики Факультета фундаментальной медицины МГУ им. М.В.Ломоносова

Москва, Россия

MD PhD, head of the center of radiation diagnostics Federal state Autonomous institution "Treatment and rehabilitation center" of the Ministry of health of the Russian Federation

Moscow, Russia

vsini@mail.ruhttps://orcid.org/0000-0002-5267-0108ДаутовТаирхан БекполатовичDautovTairkhan Bekpolatovich

заведующий отделением радиологии НАО «Национальный научный кардиохирургический центр»

Республика Казахстан

MD PhD, Head of the Radiology Department of National Scientific Center of Cardiac Surgery, Ministry of Health of the Republic of Kazakhstan

tairkhan.dautov@mail.ruhttps://orcid.org/0000-0001-6315-5016АбдрахмановАян СулейменовичAbdrakhmanovAyan Suleimenovich

заведующий отделением интервенционной аритмологии НАО «Национальный научный кардиохирургический центр»

Республика Казахстан

Head of the Department of Interventional Arrhythmology of National Scientific Center of Cardiac Surgery

Kazakhstan

ayan-3@mail.ruНациональный научный кардиохирургический центр, отделение интервенционной кардиологии и радиологии МЗ РККазахстанNational Research Cardiac Surgery Center, Department of Interventional Cardiology and Radiology, Ministry of Health of the KazakhstanKazakhstanАО «Медицинский университет Астана», кафедра радиологии №1КазахстанJSC «Astana Medical University,» Department of Radiology No.1KazakhstanМосковский государственный университет им. М.В. Ломоносова, рентгенологический факультетРоссияMoscow Lomonosov State University, Department of RadiologyRussian Federation2023300620236366168Copyright © Kardiomag, 20232023KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/2453Цель

Цель. Целью исследования было определить эффективность компьютерно-томографической ангиографии сердца (КТА) в положении пациента лежа на левом боку для диагностики тромба ушка левого предсердия (УЛП) перед катетерной аблацией, а также для оценки факторов риска тромбообразования.

Материал и методы

Материал и методы. В это ретроспективное когортное исследование был включен 101 пациент с фибрилляцией предсердий. Всем пациентам выполняли трансторакальную эхокардиографию (ЭхоКГ) и КТА сердца в положении лежа на левом боку. Чреспищеводная эхокардиография (ЧП ЭхоКГ) выполнялась для подтверждения или исключения тромба в УЛП. Пациенты с аллергическими реакциями на йодсодержащие контрастные вещества, повышенным уровнем креатинина в сыворотке крови, гипертиреозом, беременностью и возрастом < 18 лет были исключены. Для каждого пациента были рассчитаны баллы CHA2-DS2-VASc и HAS-BLED.

Результаты

Результаты. Все тромбы УЛП, обнаруженные при КТА, были подтверждены с помощью ЧП ЭхоКГ. Более высокие баллы CHA2-DS2-VASc, HAS-BLED, увеличение ЛП и его переднезаднего размера были достоверно связаны с наличием тромба УЛП. Форма УЛП в виде цветной капусты была предиктором тромбоза. Увеличение объема УЛП на 1 мл повышало вероятность тромбоза УЛП и ишемического инфаркта головного мозга на 2%. Увеличение переднезаднего диаметра УЛП на 1 см повышало риск тромбоза УЛП на 190% и инфаркта головного мозга на 78%. Увеличение баллов по шкале CHA2DS2-VASc на 1 балл повышало риск тромбоэмболии и инфаркта мозга на 12%.

Выводы

Выводы. КТА сердца, выполняемая в положении пациента лежа на левом боку, является оптимальным методом скрининга для выявления или исключения тромба УЛП перед катетерной аблацией фибрилляции предсердий. КТА имеет прогностическое значение для оценки риска тромбоза УЛП.

Aim    The study aimed to determine the efficacy of cardiac computed tomography angiography (CCTA) for diagnosing left atrial appendage (LAA) thrombus before catheter ablation with the patient in the left lateral decubitus position and, also, to evaluate the risk factors for thrombus formation.Material and methods    This retrospective, cohort study included 101 patients with atrial fibrillation. All patients underwent transthoracic echocardiography (TTE) and left lateral decubitus CCTA. Transesophageal echocardiography (TEE) was performed to confirm or exclude LAA thrombus. Patients with allergic reactions to iodinated contrast media, increased serum creatinine, hyperthyroidism, pregnancy, and age<18 years were excluded. The CHA2‑DS2‑VASc and HAS-BLED scores were calculated for each patient.Results    All LAA thrombi detected on CCTA were confirmed by TEE. Higher CHA2‑DS2‑VASc, HAS-BLED scores, enlarged LA, and the anteroposterior dimension of the left atrium were significantly associated with the presence of LAA thrombus. A LAA cauliflower shape was a predictor of thrombus. An increase of LAA volume by 1 ml increased the chances of LAA thrombus and cerebral ischemic infarct by 2 %. The growth of the LAA anteroposterior diameter by 1 cm increased the risk of LAA thrombus by 190 % and of cerebral infarct by 78 %. An increase in the CHA2DS2‑VASc score by 1 point increased the risk of thromboembolism and cerebral infarction by 12 %.Conclusions    CCTA performed in the left lateral decubitus position of the patient is an optimal screening tool to detect or exclude LAA thrombus before catheter ablation because of atrial fibrillation. CCTA has predictive value for risk of thrombosis formation in LAA.

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The authors declare that there are no conflicts of interest present.