CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 4, September/October 2023 232 AFRICA the morphology and structure of the LAA from different planes and angles and evaluate the functional status of the heart. It also serves as the gold standard for the diagnosis of LAA thrombus.7 In this study, we analysed the correlations of the CHA2DS2VASc score of 164 atrial fibrillation patients with CTA results and RT-3D-TEE measurement parameters. We investigated the application of CTA and RT-3D-TEE to predict LAA thrombosis in patients with non-valvular atrial fibrillation, so as to discover more feasible means for auxiliary examination of atrial fibrillation and related complications and improve the detection rate of LAA thrombus in such patients. Methods A total of 164 atrial fibrillation patients undergoing cardiac CTA and RT-3D-TEE in our hospital from February 2015 to February 2020 were selected as the subjects of this study. There were 97 males and 67 females aged 49–81 years (64.34 ± 9.61). The inclusion criterion involved the patients definitely diagnosed with non-valvular atrial fibrillation by means of CTA and RT-3D-TEE.8 The exclusion criteria were set as follows: patients with valvular heart disease, those with a history of cardiac surgery, those with acute or subacute endocarditis, congenital cardiac structural abnormality, cardiac insufficiency, or those who could not undergo CTA. This study was approved by the medical ethics committee of the hospital. All the patients and their families voluntarily agreed to participate in the study and signed the informed consent. The CTA data were collected by experienced radiologists using Philips Brilliance 256-slice spiral-speed CT in strict accordance with the operation specifications. A contrast-medium hypersensitivity test was performed on the patients half an hour before scanning, and 12.5–25 mg of atenolol and 25–50 mg of metoprolol were orally administered after no adverse reactions had occurred. The patients were then instructed to control their heart rate and conduct breath-holding training. The patients were scanned in the supine position, with sublingual administration of nitroglycerin tablets and connected to a high-pressure syringe and lead electrodes. A retrospective electrocardiographic gating technique was used for scanning in a single breath-hold at the end of exhalation, with a breathholding time of 10–15 seconds and a scanning range from the tracheal carina to the diaphragmatic surface of the heart. Moreover, the descending aorta at the central level of the heart was monitored as a region of interest (threshold: 110–150 HU). Subsequently, 60–80 ml of iopamidol (injection rate: 4–5 ml/s) were injected as a bolus into the cubital vein via a dual-tube highpressure syringe, and then 30–50 ml of normal saline were injected at a rate of 4.5–6 ml/s. Real-time contrast medium tracking and scanning were performed immediately, and coronary CTA scanning was executed automatically after reaching the threshold. The scanning data were transmitted to an ADW4.6 postprocessing workstation, and two experienced radiologists were responsible for the post-processing of scanned images, including surface reconstruction, maximum-intensity projection, volume rendering and surface-shaded display. An LAA thrombus would be diagnosed if filling defects in the LAA were displayed after the injection of contrast medium and the density of the defect area was remarkably different from that of the surrounding tissues. A Philips iE 33 colour Doppler ultrasonic diagnostic apparatus configured with MVQ analysis software was employed to complete RT-3D-TEE. A X7-2t multiplane probe, set at 2–7 MHz, was used for RT-3D-TEE and an X5-1 transthoracic probe was set at 1–5 MHz. First, transthoracic echocardiography was conducted to examine the cardiac morphology, structure and function of patients. Specifically, the patients were deprived of food and water for four to six hours before examination and subjected to auxiliary anaesthesia with 2% lidocaine mortar. Then the patients were placed in the supine position, with the head tilted back, the mandible raised and the mouth biting the dental pad. The X7-2t probe was smeared with an appropriate amount of coupling agent and the front end was inserted into the oesophagus, and 2D and colour Doppler ultrasonic scanning was implemented from varying depths, angles and sections when the probe reached the mid-oesophagus (30–40 cm away from the incisor teeth). Next, the probe direction was adjusted until the LAA was clearly and completely displayed, and the images were captured. Thirdly, the sampling box was adjusted under the 3D imaging mode to clearly exhibit the LAAand peripheral cardiac structures, followed by collection of 3D images. Finally, the images were observed and analysed by two experienced sonographers. An LAA thrombus could be diagnosed if there were mass shadows in the LAA at discrete ultrasound planes, which had distinct edges and different densities from the surrounding tissues. According to the CHA2DS2-VASc scoring standards, 9 heart failure, hypertension, age ≥ 75years, age = 65–74years old, diabetes mellitus, stroke/transient ischaemic attack/thromboembolism, vascular disease and female gender were recorded as one, one, two, one, one, two, one and one point, respectively, with a total score of 10 points. It was recommended that the patients with a score ≥ two points were given anticoagulants for thrombus prevention and treatment, those with a score of one point were treated with selective anticoagulants or aspirin replacement therapy, and those with a score of zero points would not receive anticoagulants or merely use aspirin treatment. The patients were assigned into group A (CHA2DS2-VASc score ≥ two points, anticoagulant treatment group, n = 112) and group B (CHA2DS2-VASc score < two points, selective anticoagulant treatment group, n = 52). Then we compared, between the two groups, clinical data such as age, gender, body mass index (BMI), disease course, paroxysmal atrial fibrillation, persistent atrial fibrillation, hypertension, diabetes mellitus, coronary heart disease, heart failure, stroke/transient ischaemic attack/thromboembolism, vascular disease, B-type natriuretic peptide, plasma fibrinogen and serum uric acid levels, CTA-based LAA classification, RT-3D-TEE measurement parameters [left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), left ventricular end-systolic diameter (LVESd), left atrial diameter (LAD), LAA flow velocity (LAAV), maximum diameter of LAA orifice, minimum diameter of LAA orifice, LAA length and early diastolic peak velocity of mitral valve (E)] and CHA2DS2-VASc score. Statistical analysis SPSS 21.0 software was utilised for statistical analysis. The normally distributed measurement data are expressed as mean ± standard deviation and the numerical data are represented as number and percentage. The t-test and chi-squared test were
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