经胸超声心动图参数与心房颤动患者左心耳血栓形成关系研究  

Relationship between parameters of transthoracic echocardiography and left atrial appendage thrombus in patients with atrial fibrillation

作　　者：俞志松 张旺东 吴轲[1] 林庚海[1] 杨鹏 戴增欢[1] Yu Zhisong;Zhang Wangdong;Wu Ke;Lin Genghai;Yang Peng;Dai Zenghuan(Department of Cardiovascular Medicine,909th Hospital of Chinese PLA Joint Logistics Support Force,Zhangzhou 363000,China.)

机构地区：[1]联勤保障部队第九〇九医院/厦门大学附属东南医院心血管内科,漳州363000

出　　处：《中国循证心血管医学杂志》2024年第1期65-68,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：福建省医学创新课题项目(2018-CX-42)

摘　　要：目的分析经胸超声心动图参数与心房颤动(房颤)患者左心耳血栓形成关系。方法回顾性分析2017年1月至2022年12月于厦门大学附属东南医院心血管内科住院收治的房颤患者临床资料,根据是否存在左心耳血栓分为血栓组(n=49)和非血栓组(n=638)。比较两组患者的实验室检查、超声心动图等参数差异。使用多因素Logistic回归分析左心耳血栓形成的独立危险因素。结果与非血栓组相比,血栓组患者平均年龄更大(P=0.040)、阵发性房颤患者比例更低(P=0.007)、CHA2DS2-VASc评分更高(P=0.004)、使用新型口服抗凝药(NOAC)治疗比例更低(P=0.004)、维生素K拮抗剂(VKA)抗凝比例更高(P=0.022)、左室射血分数(LVEF)更低(P=0.0001)、左房内径(LAD)更大(P=0.001)。多因素二元Logistic回归分析结果可见,年龄增加(OR=1.126,95%CI:1.006~1.259,P<0.001)、CHA2DS2-VASc评分升高(OR=2.154,95%CI:1.170~3.962,P=0.014)、VKA治疗(OR=1.984,95%CI:1.611~2.442,P<0.001)、LAD增加(OR=1.363,95%CI:1.068~1.737,P=0.013)是左心耳血栓形成的独立危险因素,而阵发性房颤(OR=0.528,95%CI:0.379~0.735,P<0.001)、LVEF降低(OR=0.874,95%CI:0.787~0.969,P=0.011)是左心耳血栓形成的保护因素。结论本研究证实了LVEF降低及LAD增大是房颤患者左心耳血栓形成的独立危险因素。在临床适当抗凝治疗的情况下,对于LVEF降低和左房(LA)扩大患者,尤其在合并其他血栓栓塞危险因素时,在复律或消融前仍应谨慎评估患者风险。Objective To analyze the relationship between parameters of transthoracic echocardiography(TTE)and left atrial appendage thrombus(LAAT)in patients with atrial fibrillation(AF).Methods The materials were retrospectively analyzed in AF patients hospitalized in Department of Cardiovascular Medicine in Dongnan Hospital affiliated to Xiamen University from Jan.2017 to Dec.2022.All patients were divided,according to whether they had LAAT or not,into LAAT group(n=49)and non-LAAT group(n=638).The differences in clinical biochemical data and echocardiography parameters were compared between 2 groups.The independent risk factors for LAAT thrombosis were analyzed by using multi-factor Logistic regression analysis.Results Compared with non-LAAT group,in LAAT group the average age was higher(P=0.040),percentage of paroxysmal atrial fibrillation(PAF)was higher(P=0.007),score of CHA2DS2-VASc was higher(P=0.004),percentage of treatment with novel oral anticoagulants(NOAC)was lower(P=0.004),and percentage of treatment with vitamin K antagonists(VKA)was higher(P=0.022),ventricular ejection fraction(LVEF)was lower(P=0.0001)and left atrial diameter(LAD)was larger(P=0.001).The multi-factor binary Logistic regression analysis showed that aging(OR=1.126,95%CI:1.006~1.259,P<0.001),increased score of CHA2DS2-VASc(OR=2.154,95%CI:1.170~3.962,P=0.014),VKA treatment(OR=1.984,95%CI:1.611~2.442,P<0.001)and LAD increase(OR=1.363,95%CI:1.068~1.737,P=0.013)were independent factors for LAAT thrombosis,and PAF(OR=0.528,95%CI:0.379~0.735,P<0.001)and LVEF decrease(OR=0.874,95%CI:0.787~0.969,P=0.011)were protective factors for LAAT thrombosis.Conclusion This study confirms that decreased LVEF and increased LAD are independent risk factors for LAAT thrombosis in AF patients.In clinical practice,even with appropriate anticoagulation therapy,for patients with decreased LVEF and enlarged left atrium,especially when other thromboembolic risk factors coexist,the risk should be carefully evaluated before cardioversion or ablation.

关 键 词：心房颤动 左心耳 超声心动图 左室射血分数 

分 类 号：R571.75[医药卫生—消化系统]