左心房/左心耳自发显影的临床特征及与左心房内径的关系  

Clinical features of LA/LAA spontaneous echo contrast and its relationship with LAD

作　　者：吴燕[1] 马望歌 宁菲菲[1] 高立 文雯[1] 周娟[1,2] WU Yan;MA Wangge;NING Feifei;GAO Li;WEN Wen;ZHOU Juan(Department of Cardiovascular Medicine,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061;Key Laboratory of Molecular Cardiology of Shaanxi Province,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院心血管内科,陕西西安710061 [2]陕西省分子心脏病学重点实验室,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2022年第4期554-559,共6页Journal of Xi’an Jiaotong University（Medical Sciences）

摘　　要：目的分析非瓣膜性心房颤动(nonvalvular atrial fibrillation,NVAF)患者左心房/左心耳(left atrial and left atrial appendage,LA/LAA)自发显影的临床特征,探讨其与左心房内径的关系。方法对2019年11月-2021年1月我院心内科住院的262例NVAF患者的临床资料(包括性别、年龄及高血压、糖尿病、脑卒中或短暂性脑缺血发作、血管疾病病史等)、实验室检查结果(包括凝血功能、血常规、甲功等)及经胸心脏超声测量参数进行数据收集及回顾性分析。根据经食管心动超声结果分为对照组和自发显影组。采用Logistic回归分析LA/LAA自发显影的影响因素。采用ROC曲线评价左心房内径对LA/LAA自发显影的预测价值。结果LA/LAA自发显影的患者中,非阵发性心房颤动所占比例更高(65.9%vs.32.2%,P<0.001),其CHA_(2)DS_(2)-VASc评分显著高于对照组(P=0.003)。与对照组比较,自发显影组左心房内径、左心室收缩末/舒张末内径显著增大,左心室射血分数显著降低,氨基末端脑钠肽前体(NT-proBNP)水平明显升高(P<0.05)。Logistic回归分析显示,非阵发性心房颤动(OR=2.451;95%CI:1.260~4.766;P<0.05)、CHA_(2)DS_(2)-VASc评分(OR=1.236;95%CI:1.023~1.494;P<0.05)、左心房内径(OR=1.086;95%CI:1.019~1.157;P<0.05)是LA/LAA自发显影的独立影响因素。ROC曲线评价左心房内径预测LA/LAA自发显影的曲线下面积为0.731(95%CI:0.668~0.794;P<0.001)。结论左心房内径与NVAF患者LA/LAA自发显影密切相关,结合心房颤动类型、CHA_(2)DS_(2)-VASc评分,对NVAF患者血栓栓塞风险具有潜在预测价值。Objective To analyze the clinical features of nonvalvular atrial fibrillation(NVAF)patients with left atrial/left atrial appendage spontaneous echo contrast(LA/LAASEC),and investigate the correlation between LA/LAASEC and left atrial diameter.Methods Clinical data(including gender,age,and history of hypertension,diabetes,stroke or transient ischemic attack,vascular disease),laboratory indexes(including coagulation indicators,blood routine,thyroid function),and transthoracic echocardiogram parameters of 262 NVAF patients hospitalized in the Department of Cardiovascular Medicine of our hospital from November 2019 to January 2021 were collected and analyzed retrospectively.According to the results of transesophageal echocardiography,they were divided into control group and LA/LAASEC group.Logistic regression analysis was performed to investigate the influencing factors of LA/LAASEC.ROC curve analysis was used to evaluate the predictive value of left atrial diameter for LA/LAASEC.Results The proportion of nonparoxysmal atrial fibrillation was significantly higher in LA/LAASEC patients than the controls(65.9%vs.32.2%,P<0.01),and so was the CHA_(2)DS_(2)-VASC score(P=0.003).Compared with the control group,left atrial diameter and left ventricular end-systolic/end-diastolic diameters were significantly increased,left ventricular ejection fraction was significantly decreased,and the level of NT-proBNP was significantly increased in LA/LAASEC group(P<0.05).Logistic regression analysis showed that non-paroxysmal AF(OR=2.451,95%CI:1.260-4.766,P<0.05),CHA_(2)DS_(2)-VASc score(OR=1.236,95%CI:1.023-1.494,P<0.05),and left atrial diameter(OR=1.086,95%CI:1.019-1.157,P<0.05)were independent risk factors for LA/LAASEC.ROC curve analysis displayed that the AUC for left atrial diameter in predicting LA/LAASEC was 0.731(95%CI:0.668-0.794,P<0.001).Conclusion Left atrial diameter is closely related to LA/LAASEC in NVAF patients.Combined with atrial fibrillation type and CHA_(2)DS_(2)-VASC score,it has a potential value in predicting the

关 键 词：自发显影 左心房内径 非阵发性心房颤动 CHA_(2)DS_(2)-VASc评分 心律失常 

分 类 号：R541.7[医药卫生—心血管疾病]