阵发性心房颤动患者左心耳血栓形成的超声预测因素分析  

Echocardiographic predictors of left atrial appendage thrombus formation in patients with paroxysmal atrial fibrillation

作　　者：郭冠军[1] 方爱娟[1] 周铭[1] 孙步高[1] GUO Guan-jun;FANG Ai-juan;ZHOU Ming;SUN Bu-gao(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：《岭南心血管病杂志》2022年第1期50-54,共5页South China Journal of Cardiovascular Diseases

基　　金：南京市医学科技发展项目(项目编号:YKK18086)。

摘　　要：目的探讨阵发性心房颤动(paroxysmal atrial fibrillation,PAF)患者左心耳血栓形成的影响因素。方法选择2017年至2019年南京大学医学院附属鼓楼医院拟行导管消融术的PAF患者560例,根据经食管超声心动图结果分为左心耳血栓组(27例)和无血栓组(533例)。对两组患者临床特征、经胸和经食管超声心动图结果进行统计比较,Logistic回归分析筛选左心耳血栓形成的影响因素并以受试者工作特征曲线(receiver operating characteristic curve,ROC)评价其预测效力。结果与无血栓组比较,血栓组患者窦性心律比例(18.52%vs.64.17%,P<0.001)、左心室射血分数(left ventricular ejection fraction,LVEF)[(52.52±7.82)%vs.(57.14±5.42)%,P=0.005]、左心耳充盈速度(left atrial appendage-filling velocity,LAA-FV)[(25.70±8.40)cm/s vs.(47.03±13.83)cm/s,P<0.001]和左心耳排空速度(left atrial appendage-emptying velocity,LAA-EV)[(26.07±8.44)cm/s vs.(54.60±13.57)cm/s,P<0.001]更低,而心力衰竭患者比例(18.52%vs.5.44%,P=0.019)、左心耳口径(left atrial appendage orifice diameter,LAA-O)[(20.10±2.96)mm vs.(17.02±2.47)mm,P<0.001]、左心耳深度(left atrial appendage depth,LAA-D)[(29.97±3.39)mm vs.(26.77±3.49)mm,P<0.001]、室间隔厚度(interventricular septal thickness,IVST)[(10.45±2.43)mm vs.(9.18±1.60)mm,P=0.013]、左心室后壁厚度(left ventricle posterior wall thickness,LVPWT)[(9.87±1.93)mm vs.(8.92±1.20)mm,P=0.017]、左心房内径(left atrial diameter,LAD)[(47.69±3.49)mm vs.(41.97±5.05)mm,P<0.001]、左心房横径(transverse left atrial diameter,LADt)[(45.76±2.48)mm vs.(41.20±4.63)mm,P<0.001]、左心房长径(longitudinal left atrial diameter,LADl)[(58.73±4.68)mm vs.(52.54±5.55)mm,P<0.001]、右心房横径(transverse right atrial diameter,RADt)[(42.80±3.22)mm vs.(38.80±4.47)mm,P<0.001]、右心房长径(longitudinal right atrial diameter,RADl)[(55.11±4.19)mm vs.(50.39±5.21)mm,P<0.001]均更大,差异有统计学意义(P<0.05)。Logistic回归分析显示LAA⁃Objectives To investigate the risk factors of left atrial appendage thrombus(LAAT)in patients with parox⁃ysmal atrial fibrillation(PAF).Methods Totally 560 patients with PAF were divided into LAAT group(n=27)and non LAAT group(n=533)from 2017 to 2019 in Nanjing Drum Tower Hospital according to the results of transesophageal echocardiography(TEE).Clinical data,transthoracic and TEE findings were analyzed.Risk factors of LAAT were ana⁃lyzed by Logistic regression analysis and their predictive effectiveness were evaluated by receiver operating characteristic curve(ROC).Results Significant differences between LAAT group and non LAAT group were observed in sinus rhythm(18.52%vs.64.17%,P<0.001),heart failure(18.52%vs.5.44%,P=0.019),left ventricular ejection fraction(LVEF)[(52.52±7.82)%vs.(57.14±5.42)%,P=0.005],interventricular septal thickness(IVST)[(10.45±2.43)mm vs.(9.18±1.60)mm,P=0.013],left ventricle posterior wall thickness(LVPWT)[(9.87±1.93)mm vs.(8.92±1.20)mm,P=0.017],left atrial diameter(LAD)[(47.69±3.49)mm vs.(41.97±5.05)mm,P<0.001],transverse left atrial diameter(LADt)[(45.76±2.48)mm vs.(41.20±4.63)mm,P<0.001],longitudinal left atrial diameter(LADl)[(58.73±4.68)mm vs.(52.54±5.55)mm,P<0.001],transverse right atrial diameter(RADt)[(42.80±3.22)mm vs.(38.80±4.47)mm,P<0.001],longitudinal right atrial diameter(RADl)[(55.11±4.19)mm vs.(50.39±5.21)mm,P<0.001],left atrial appendage-filling velocity(LAA-FV)[(25.70±8.40)cm/s vs.(47.03±13.83)cm/s,P<0.001],left atrial appendage emptying velocity(LAA-EV)[(26.07±8.44)cm/s vs.(54.60±13.57)cm/s,P<0.001],left atrial appendage orifice diameter(LAA-O)[(20.10±2.96)mm vs.(17.02±2.47)mm,P<0.001]and left atrial appendage depth(LAA-D)[(29.97±3.39)mm vs.(26.77±3.49)mm,P<0.001].Further Logistic regression analysis indicated that LAA-EV and LAA-O were independent factors of LAAT.ROC analysis showed that the cutoff 38.5 cm/s of LAA-EV[area under the curve(AUC)=0.966,95%CI:0.940-0.993,P<0.001]predicted LAAT with specificity of 96.3%and sensitivity of 90.6%,and

关 键 词：心房颤动 左心耳血栓 左心耳排空速度 左心耳口径 

分 类 号：R541.7[医药卫生—心血管疾病]