Stoddard Marcus F, Singh Pradeep, Dawn Buddhadeb, Longaker Rita A
Department of Medicine, Division of Cardiology, University of Louisville, Louisville, Ky 40292, USA.
Am Heart J. 2003 Apr;145(4):676-82. doi: 10.1067/mhj.2003.91.
Atrial fibrillation (AF) is widely accepted as a direct cause of cardioembolic stroke from left atrial (LA) thrombus formation. However, the relationship between LA thrombus and transient ischemic attack (TIA) in patients with AF is less well established.
Two hundred sixty-one adult patients (mean age 66 +/- 11 years, 220 men and 41 women) with AF undergoing transesophageal echocardiography (TEE) were prospectively followed up for TIA (mean duration 30.3 +/- 20.6 months).
LA thrombus was present in 18% (n = 46) and LA spontaneous echocardiographic contrast in 50% (n = 131) of the group. Nineteen of 261 patients had TIA during follow-up. Multivariate logistic regression showed congestive heart failure (CHF) as the only predictor of TIA when a model of clinical variables was constructed (odds ratio [OR] 2.7, P =.04). Age, sex, hypertension, and use of warfarin or aspirin were not predictors. When TEE variables were added to the model, LA thrombus became the only predictor of TIA (OR 7.7, P =.0001). Survival free of TIA (Kaplan-Meier) was significantly less (P =.0001) in patients with LA thrombus compared with those without, and the annual TIA event rate was 9.2% per year versus 1.9% per year (P <.0001), respectively.
To our knowledge, this is the first prospective study documenting an association between LA thrombus and TIA in patients with AF. Other TEE variables, including aortic atheromata, and clinical parameters were not independently predictive. These data support a likely thromboembolic mechanism for TIA from LA thrombus in patients with AF.
心房颤动（AF）被广泛认为是左心房（LA）血栓形成导致心脏栓塞性卒中的直接原因。然而，AF患者中LA血栓与短暂性脑缺血发作（TIA）之间的关系尚不明确。
对261例接受经食管超声心动图（TEE）检查的成年AF患者（平均年龄66±11岁，男性220例，女性41例）进行前瞻性随访以观察TIA情况（平均随访时间30.3±20.6个月）。
该组患者中18%（n = 46）存在LA血栓，50%（n = 131）存在LA自发超声造影。261例患者中有19例在随访期间发生TIA。构建临床变量模型时，多因素逻辑回归显示充血性心力衰竭（CHF）是TIA的唯一预测因素（比值比[OR] 2.7，P = 0.04）。年龄、性别、高血压以及华法林或阿司匹林的使用并非预测因素。当将TEE变量纳入模型时，LA血栓成为TIA的唯一预测因素（OR 7.7，P = 0.0001）。与无LA血栓的患者相比，有LA血栓的患者无TIA生存时间（Kaplan-Meier法）显著缩短（P = 0.0001），每年TIA事件发生率分别为9.2%和1.9%（P < 0.0001）。
据我们所知，这是第一项前瞻性研究证实AF患者中LA血栓与TIA之间存在关联。其他TEE变量，包括主动脉粥样硬化和临床参数，并非独立预测因素。这些数据支持AF患者中LA血栓导致TIA可能存在血栓栓塞机制。
