Cardiac CT에서 심장주기에 따른 좌심방이의 크기 변화에 관한 연구 = A Study on the Correlation the Cardiac Cycle and the Size of the Left Atrial Appendage in Cardiac CT

국문 초록 (Abstract)

본 연구는 심방세동 환자의 경피적 좌심방이 폐색술에 따른 부작용을 최소화하기 위해 좌심방이의 형태학적 변화를 분석하고, 적합한 장치 크기를 선정하기 위한 최적의 심장주기를 알아보고자 하였다. 지속성 심방세동 환자 31명과 발작성 심방세동 중 동리듬 환자 69명을 대상으로 전체 심장주기에서 10% 간격으로 좌심방이의 입구와 안착지점에서 최대 직경, 평균 직경, 둘레 기반 직경을 측정하였다. 측정 값을 이용하여 좌심방이의 구간별 크기 값의 분포를 분석하고 최댓값과 최솟값의 상대적 차이 및 일원배치 분산분석을 통해 각 심장주기 구간별 평균값의 차이를 확인하였다. 또한 최대 크기를 나타내는 심장주기의빈도를 분석하고, 관찰자 간 측정값의 신뢰도를 평가하였다. 연구 결과, 좌심방이 입구와 안착지점 모두 수축기, 특히 40% 구간에서 최대 직경, 평균 직경, 둘레 기반 직경이 가장 크게 나타났으며, 이완기말로 진행될수록 크기가 감소하였다. 심방세동군의 상대적 차이는 입구와 안착지점에서 모두 50% 이상이었으며, 동리듬 환자군에서는 70% 이상 차이를 나타냈다. 일원배치 분산분석 결과, 각 심장주기 구간별 좌심방이의 크기는 유의한 차이가 있었다.(p<0.05) 심장주기별 최댓값이 나타나는 빈도 분석에서는 두 구역 모두 40% 구간에서 최댓값의 빈도가 가장 높았다. 좌심방이 크기 측정에 대한 3인의 관찰자 간 신뢰도평가 결과는 매우 우수한 일치도를 보였다.(ICC＞0.8) 모든 환자군에서 좌심방이의 최대 크기가 나타난 심장주기는 수축기 구간이었으며, 특히 40% 구간에서 가장 크게 나타났다. 따라서 경피적 좌심방이 폐색술 시행 전 심장주기 중 40% 구간에서 좌심방이의 크기를 측정한다면, 측정 오류를 최소화하여 적합한 장치의 크기 선택에 도움이 될 것으로 사료된다.

다국어 초록 (Multilingual Abstract)

This study aimed to analyze the size changes of the left atrial appendage in atrial fibrillation patients to minimize complications of left atrial appendage occlusion and to determine the optimal cardiac cycle for selecting the appropriate device size. The study included 31 persistent atrial fibrillation patients and 69 paroxysmal atrial fibrillation patients in sinus rhythm, measuring the maximum, mean and perimeter-derived diameters of the left atrial appendage's orifice and landing zone at 10% intervals throughout the entire cardiac cycle. Analyzes included the distribution of size values for each cycle, one-way ANOVA, relative differences, frequency of maximum values, and interobserver reliability. As a result, the maximum, mean and perimeter-derived diameter of the left atrial appendage orifice and landing zone all showed maximum size value in the systolic phase, especially in the 40%. As it progressed towards end-diastole, the diameter progressively decreased. The relative differences in the atrial fibrillation group were more than 50% at both the orifice and landing zone, and in the sinus rhythm group, these differences exceeded 70% at the same points. The One-way ANOVA revealed significant differences in the left atrial appendage size in each cardiac cycle(p<0.05) Frequency analysis showed that the 40% had the highest occurrence of maximum values for both areas. The assessment of interobserver reliability showed excellent consistency. All groups, the cardiac cycle phase showing the maximum left atrial appendage size was the systolic phase, especially at the 40% phase. Therefore, measuring the size of the left atrial appendage at 40% of the cardiac cycle before left atrial appendage occlusion may help minimize measurement errors and aid in selecting an appropriate device size.

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