ABSTRACT
Objective To systematically evaluate the differences in preoperative planning for left atrial appendage closure(LAAC)using cardiac CT angiography(CCTA)and transesophageal echocardiography(TEE).Methods Relevant studies comparing CCTA and TEE for preoperative assessment of LAAC published from the inception of each database to July 18,2023,were searched in PubMed,EMBASE,the Cochrane Library,CNKI,Wanfang,and CBM database.Meta-analysis was performed using RevMan 5.4 and Stata 15.1.Results A total of 21 studies with 2 137 patients were included.Compared to TEE,preoperative CCTA measurement of the left atrial appendage(LAA)showed a larger maximum diameter(MD 2.27 mm,95％CI 1.70-2.83,P＜0.001)and higher accuracy in predicting occlusion device(RR 1.67,95％CI 1.39-2.01,P＜0.001).Subgroup analysis based on whether 3D reconstruction was performed and occlusion device type showed similar results.There was no statistically significant difference in the surgical success rate(RR 1.03,95％CI 0.98-1.08,P=0.230)between the two imaging methods.Additionally,preoperative 3D reconstruction based on CCTA resulted in fewer occlusion devices used(MID-0.29,95％CI-0.53--0.04,P=0.020),less contrast agent usage(MD-4.48 ml,95％CI-7.40—-1.56,P=0.003),shorter operative time(MD-14.98 min,95％CI-17.79—-12.17,P＜0.001),and a lower rate of postoperative residual leakage(RR 0.59,95％CI 0.36-0.99,P=0.040).Conclusions Compared to TEE,preoperative CCTA for LAAC improves the accuracy of occlusion device prediction.3D reconstruction based on CCTA reduces the occlusion devices used and the usage of contrast agents,shortens the operative time,improves surgical efficiency,and is associated with a lower rate of postoperative residual leakage.Therefore,CCTA has more advantages in preoperative planning for LAAC.
ABSTRACT
Objectives: To investigate the predictive value of CHA2DS2-VASc score for contrast induced nephropathy (CIN) after percutaneous coronary intervention in patients with coronary heart disease. Methods: A total of 356 patients undergoing elective percutaneous coronary intervention were enrolled in this study. The patients were divided into two groups according to the CHA2DS2-VASc score: CHA2DS2-VASc score ≥ 3 (n=153) and ≤ 2 (n=203). Baseline data, incidence of CIN and major adverse cardiovascular events were analyzed and compared between the two groups. The predictive effect of CHA2DS2-VASc score was analyzed with receiver operating characteristic curve (ROC) and logistic regression analysis. Results: Left ventricular ejection fraction was significantly lower, baseline serum creatinine value was significantly higher, coronary lesions were more complex, contrast agent dosage used was significantly larger and the incidence of CIN was significantly higher in patients of the CHA2DS2-VASc score ≥ 3 group than in patients of CHA2DS2-VASc score ≤ 2 group (all Pvalues<0.05). Multivariate logistic regression analysis showed that CHA2DS2-VASc score≥3 was an independent predictor of CIN (OR=2.152, 95% CI: 1.261-3.987, P=0.032). The area under the curve of ROC of CHA2DS2-VASc score ≥ 3 for predicting CIN was 0.749 (sensitivity 76.9%, specificity 73.0%). Conclusions: CHA2DS2-VASc score could predict the CIN after percutaneous coronary intervention in patients with coronary heart disease, which could help us identify the high-risk patients of CIN and take preventive measures to reduce the incidence of CIN post percutaneous coronary intervention.