左心房内径联合心脏节律预测非瓣膜性心房颤动患者左心耳血栓形成的价值  

Left atrial diameter combined with heart rhythm predicts left atrial appendage thrombus in patients with non-valvular atrial fibrillation

作　　者：郭冠军[1] 方爱娟[1] 杨益宁[1] 周铭[1] 彭钰[1] 张宁[1] 李捷[1] GUO Guanjun;FANG Aijuan;YANG Yining;ZHOU Ming;PENG Yu;ZHANG Ning;LI Jie(Department of Cardiology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing,210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院心血管内科,南京210008

出　　处：《临床心血管病杂志》2020年第7期613-616,共4页Journal of Clinical Cardiology

摘　　要：目的:评估临床及心脏超声指标预测非瓣膜性心房颤动患者左心耳血栓形成的价值。方法:非瓣膜性心房颤动患者688例,以经食管超声心动图检查结果分为左心耳血栓组(38例)和无血栓组(650例)。对两组患者临床特征及经胸超声心动图检查结果进行统计分析,筛选血栓形成的影响因素并评价其预测效力。结果:与无血栓组比较,血栓组患者检查时窦性心律比例和LVEF更低,合并心力衰竭比例、CHA2DS2-VASc评分、三尖瓣反流、IVST、LVPWT、LAD、RADz和RADl均更高。Logistic回归分析显示LAD和心脏节律是血栓形成的独立影响因素。ROC曲线以LAD 43.55 mm为截值预测血栓形成的敏感度为92.1%,特异性为59.7%,曲线下面积0.805(P<0.001,95%CI 0.751~0.859)。LAD联合心脏节律预测的曲线下面积达0.810(P<0.001,95%CI 0.749~0.870)。结论:LAD是非瓣膜性心房颤动患者左心耳血栓形成强有力的影响因素,LAD联合心脏节律可提高预测左心耳血栓形成的效力。Objective:To investigate the risk factors of left atrial appendage thrombus(LAAT)in patients with non-valvular atrial fibrillation(NVAF).Method:The 688 patients with NVAF were divided into LAAT group(n=38)and non LAAT group(n=650).Clinical data and transthoracic echocardiograpy(TTE)findings were analyzed.Result:Significant differences were observed in heart rhythm(HR),LVEF,HF,CHA2 DS2-VASc score,TR,IVST,LVPWT,LAD,RADz and RADl.Further logistic regression analysis indicated that LAD and HR were independent factors of LAAT.ROC showed the cutoff 43.55 mm of LAD(AUC 0.805,P<0.001,95%CI 0.751-0.859)predicted LAAT with sensitivity of 92.1%and specificity of 59.7%.LAD combined with HR yielded a greater AUC of 0.810(P<0.001,95%CI 0.749-0.870).Conclusion:LAD is a powerful risk factor of LAAT in patients with NVAF,and its predictive value can be enhanced when combined with HR.

关 键 词：非瓣膜性心房颤动 左心耳血栓 心脏节律 影响因素 

分 类 号：R541.7[医药卫生—心血管疾病]