CHA_(2)DS_(2)-VASc-BLAF评分对左心房血栓/自发显影形成的预测价值  

Value of CHA_(2)DS_(2)-VASc-BLAF in Predicting Left Atrial Thrombus/Spontaneous Echocardiographic Contrast

作　　者：王光宇 李光宇 胡锋 王新华[1] 臧敏华[1] 卜军[1] WANG Guangyu;LI Guangyu;HU Feng(Department of Cardiology,School of Medicine,Renji Hospital,Shanghai Jiao Tong University,Shanghai 200127 China)

机构地区：[1]上海交通大学医学院附属仁济医院心内科,200127

出　　处：《医学研究杂志》2023年第6期138-142,41,共6页Journal of Medical Research

摘　　要：目的评估自行改良的CHA_(2)DS_(2)-VASc-BLAF评分对经食道超声(transesophageal echocardiography,TEE)检出左心房血栓/自发显影(left atrial thrombus/spontaneous echocardiographic contrast,LAT/SEC)的预测价值。方法连续纳入2019年1月~2021年12月在上海仁济医院住院的790例非瓣膜性心房颤动(non-valvular atrial fibrillation,NVAF)患者,其中TEE检出LAT/SEC者240例(LAT/SEC组),未检出者550例(非LAT/SEC组)。对患者一般情况、既往病史、临床检验指标和超声影像学指标等相关因素进行单因素和多因素Logistic回归分析,根据Logistic回归和受试者工作特征(receiver operating characteristic,ROC)曲线分析结果,将独立预测因素左心房内径(left atrial diameter,LAD)>41.5mm、脑钠肽(brain natriuretic peptide,BNP)>93.4pg/ml和非阵发性心房颤动(non-paroxysmal atrial fibrillation,NPAF)各记为1分,加入CHA_(2)DS_(2)-VASc评分中组成新的评分方案CHA_(2)DS_(2)-VASc-BLAF。评估CHA_(2)DS_(2)-VASc-BLAF评分方案对NVAF患者LAT/SEC形成的预测价值。结果对CHA_(2)DS_(2)-VASc和CHA_(2)DS_(2)-VASc-BLAF两种评分进行ROC曲线检测发现,CHA_(2)DS_(2)-VASc预测价值偏低[曲线下面积(area under the curve,AUC)=0.661,P<0.001],CHA_(2)DS_(2)-VASc-BLAF预测价值显著升高(AUC=0.771,P<0.001)。在中危组中,若BNP>93.4pg/ml或LAD>41.5mm或存在NPAF时,LAT/SEC发生率显著升高。结论CHA_(2)DS_(2)-VASc-BLAF评分较CHA_(2)DS_(2)-VASc评分系统能更好地预测NVAF患者的LAT/SEC形成。在中危患者组中,若BNP或LAD大于阈值,或存在NPAF,LAT/SEC发生率显著升高。Objective To evaluate the predictive value of self-modified CHA_(2)DS_(2)-VASc-BLAF score in prediction left atrial thrombus/spontaneous echocardiographic contrast(LAT/SEC)in patients with non-valvular atrial fibrillation(NVAF).Methods A total of 790NVAF patients were included and received examination of transesophageal echocardiography(TEE).LAT/SEC was found in_(2)40 patients(LAT/SEC group)but absent in the remaining 550 patients(non-LAT/SEC group).The patients′general condition,medical history,and indicators of clinical blood examination and ultrasound imaging were analyzed by univariate regression and multivariate Logistic regression.Then a new CHA_(2)DS_(2)-VASc-BLAF scoring system was formed by combining left atrial diameter(LAD),brain natriuretic peptide(BNP),non-paroxysmal atrial fibrillation(NPAF)and CHA_(2)DS_(2)-VASc score.One point was assigned for each of LAD>41.5mm,BNP>93.4pg/ml and NPAF.The receiver operating characteristic(ROC)curve was used to evaluate the value of CHA_(2)DS_(2)-VASc-BLAF scores for predicting LAT/SEC formation in NVAF patients.Results The predictive value of CHA_(2)DS_(2)-VASc was low[area under the curve(AUC)=0.661,P<0.001].After being added with BNP,LAD and NPAF,the predictive value of CHA_(2)DS_(2)-VASc was significantly increased than CHA_(2)DS_(2)-VASc alone(AUC=0.771,P<0.001).In the moderate risk group,if BNP or LAD was higher than cut-off values,or NPAF existed,the incidence of LAT/SEC rose significantly.Conclusion The performance of CHA_(2)DS_(2)-VASc-BLAF score was better than CHA_(2)DS_(2)-VASc score in predicting LAT/SEC formation.For patients in the moderate risk group,the incidence of LAT/SEC increased significantly when BNP or LAD was higher than cut-off values,or NPAF existed.

关 键 词：非瓣膜性心房颤动 左心房血栓/左心房自发显影 CHA_(2)DS_(2)-VASc评分 CHA_(2)DS_(2)-VASc-BLAF评分 

分 类 号：R541.7[医药卫生—心血管疾病]