左心耳血流速度对非瓣膜性心房颤动患者左心耳血栓形成的预测价值评估  

Predictive Value of Left Atrial Appendage Blood Flow Velocity for Left Atrial Appendage Thrombus Formation in Patients With Non-valvular Atrial Fibrillation

作　　者：郭楚娴 杨龙 张敏 霍照美 何炯红[3] 杨英[3] 欧巧巧 田龙海[3] 田野[3] GUO Chuxian;YANG Long;ZHANG Min;HUO Zhaomei;HE Jionghong;YANG Ying;OU Qiaoqiao;TIAN Longhai;TIAN Ye(Graduate School of Guizhou Medical University,Guiyang(550004),Guizhou,China)

机构地区：[1]贵州医科大学研究生院,贵州省贵阳市550004 [2]贵州省首钢水钢总医院心内科 [3]贵州省人民医院心内科

出　　处：《中国循环杂志》2022年第8期831-835,共5页Chinese Circulation Journal

基　　金：贵州省科技平台及人才团队计划{黔科合平台人才[(2017)5405]};贵州省六盘水市科技创新平台和人才团队项目(52020-2020-0909)。

摘　　要：目的:探讨左心耳(LAA)血流速度对非瓣膜性心房颤动(NVAF)患者LAA血栓形成的预测价值。方法:连续入选2016年5月至2021年10月确诊NVAF且行经食道超声心动图(TEE)检查的患者485例,依据TEE检查结果将患者分为LAA血栓组(n=74)及LAA无血栓组(n=411)。收集患者临床资料和辅助检查结果,记录LAA充盈速度及排空速度。对两组患者之间差异具有统计学意义的指标进行多因素Logistic回归分析;绘制ROC曲线评估LAA血流速度对LAA血栓形成的预测价值并计算其最佳截断流速。结果:两组间左心室射血分数、左心室舒张末期内径、左心房内径、LAA充盈速度、LAA排空速度差异具有统计学意义(P均<0.01)。将上述指标纳入多因素Logistic回归分析,结果显示,校正混杂因素后,LAA充盈速度为LAA血栓形成的独立预测因素(OR=19.264,95%CI:1.386~267.719,P<0.05),其预测LAA血栓形成的AUC为0.635(95%CI:0.556~0.715,P<0.01),最佳截断流速为0.43 m/s;此时LAA充盈速度预测LAA血栓形成的灵敏度为51%、特异度为78%。结论:LAA充盈速度为LAA血栓形成的独立预测因素,其对LAA血栓形成具有一定的预测价值,当LAA充盈速度<0.43 m/s时,需警惕LAA血栓形成。Objectives:To investigate the predictive value of left atrial appendage(LAA)blood flow velocity for risk of LAA thrombus in patients with non-valvular atrial fibrillation(NVAF).Methods:A total of 485 consecutive patients who were diagnosed with NVAF and underwent transesophageal echocardiography(TEE)examination from May 2016 to October 2021 were enrolled and divided into LAA thrombus group(n=74)and non-thrombus group(n=411)based on TEE examination results.Clinical data and examination results of patients including filling rate and emptying rate of LAA were collected.Multivariate logistic regression analysis was performed to define independent determinants of LAA thrombus.ROC curve was used to evaluate the predictive value of LAA flow velocity for LAA thrombosis.Results:There were statistically significant differences in left ventricular ejection fraction,left ventricular end-diastolic diameter,left atrial anterior and posterior diameter,LAA filling velocity and LAA emptying velocity between the two groups(all P<0.01).The above indicators were included in multivariate logistic regression analysis,and the results showed that after adjusting for confounding factors,LAA filling speed served as an independent predictor of LAA thrombosis(OR=19.264,95%CI:1.386-267.719,P<0.05),the area under ROC curve for predicting LAA thrombosis was 0.635(95%CI:0.556-0.715,P<0.01),and the optimal cut-off flow rate was 0.43 m/s.The sensitivity and specificity of LAA filling rate with 0.43 m/s as cut-off value for predicting LAA thrombosis were 51%and 78%,respectively.Conclusions:LAA filling velocity is an independent predictor for LAA thrombosis and could be used to predict LAA thrombosis in NVAF patients.When the LAA filling velocity is<0.43 m/s,LAA thrombosis needs to be alerted in these patients.

关 键 词：心房颤动 左心耳血栓 左心耳血流速度 经食道超声心动图 

分 类 号：R54[医药卫生—心血管疾病]