左心耳解剖形态与CHADS2评分≤1分的心房颤动患者的血栓栓塞风险  

Left atrial appendage morphology and thromboembolic risk in patients with atrial fibrillation and CHADS2 score ≤ 1 ： a case-control study

作　　者：齐淑媛[1] 田颖[1] 石亮[1] 王彦江[1] 卢晓英[1] 陈汝明[1] 尹先东[1] 刘小青[1] 徐琳[1] 杨新春[1] 刘兴鹏[1] 

机构地区：[1]首都医科大学附属北京朝阳医院心脏中心,100020

出　　处：《中华心律失常学杂志》2015年第2期94-98,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金（81470023,81100125,81307293）

摘　　要：目的 探讨左心房（LA）及左心耳（LAA）形态学指标对CHADS2评分≤1分的心房颤动（房颤）患者血栓栓塞风险的评估价值.方法 连续入选2011年5月至2015年1月就诊于首都医科大学附属北京朝阳医院房颤中心拟行导管消融术的房颤患者562例.其中年龄≥18岁、CHADS2评分≤1分,且经食管超声心动图证实存在LAA血栓的患者25例作为A组,根据A组的年龄、性别及CHADS2评分按1∶3的比例匹配75例房颤患者作为B组.B组患者既往无脑卒中史,同时经食管超声心动图证实LAA无血栓形成.所有患者[年龄（60.2±8.5）岁,男性占84.0％]术前均行LA肺静脉双源螺旋CT检查.比较两组患者的LA及LAA解剖形态学指标.结果 A组非鸡翅型形态（22例,88.0％）较B组（46例,61.3％）增多（P=0.013）.与B组相比,A组患者的LA容积[（153.3±58.3）ml对（107.1±35.8）ml,P=0.001]及LA/LAA容积比值（16.1±7.2对13.0±6.5,P=0.043）均显著增大.多因素Logistic回归分析显示,非鸡翅型LAA形态及LA容积为CHADS2评分≤1分的房颤患者发生血栓栓塞事件的独立预测因素,两者在Logistic多元回归模型中的ROC曲线下面积为0.790.结论 非鸡翅型LAA形态可能与CHADS2评分≤1分的房颤患者的血栓栓塞风险增加相关;同时,较大的LA容积也是增加血栓栓塞风险的因素.Objective We aimed to explore the relationship of anatomical and morphological characteristics of left atrial（LA） and left atrial appendage（LAA） and the thromboembolic risk in patients with atrial fibrillation（AF） and CHADS2 score ≤ 1.Methods In this study,100 patients with non-valvular AF were enrolled [age,（60.2± 8.5） years;male,84.0％] and divided into 2 groups.In group A,all 25 patients met all of the following inclusion criteria：① ≥ 18 years;②CHADS2 ≤ 1 before the index stroke;③ the presence of thrombus in LAA revealed by transesophageal echocardiography（TEE）.Group B comprised of 75 AF patients with age-and gender-matched and met all the above criteria excepting the history of ischemic stroke and the presence of LAA thrombus.All patients underwent preprocedural cardiac dual source computed tomography （DSCT） and TEE.Anatomical and morphological characteristics of LA and LAA were compared between the two groups.Results Non-Chicken Wing LAA morphology in group A was more than that in group B [22 （88.0％） vs.46（61.3％）,P=0.013].Compared with group B,LA volume and LA/LAA volume ratio were significantly larger in group A [（153.3±58.3） ml vs.（107.1 ±35.8） ml,P=0.001;16.1 ± 7.2 vs.13.0± 6.5,P =0.043,respectively].Using logistic regression model,LA volume and non-Chicken Wing LAA morphology were independently associated with thromboembolic events.The area under the ROC curve was 0.790.Conclusion Non-Chicken Wing LAA morphology may be associated with an increased risk of thromboembolism in patients with AF and CHADS2 score≤ 1.Larger LA volume may also increase the potential thromboembolic risk in these patients.

关 键 词：左心耳 心房颤动 CHADS2评分 血栓栓塞风险 

分 类 号：R541.75[医药卫生—心血管疾病]