心房颤动患者左心房血栓及自发超声心动图显影的临床预测因素
Clinical predictors of left atrial thrombus and spontaneous echocardiographic contrast in patients with atrial fibrillation.
作者信息
Rader Valerie J, Khumri Taiyeb M, Idupulapati Madhuri, Stoner Casey N, Magalski Anthony, Main Michael L
机构信息
Mid America Heart Institute, Kansas City, Missouri, USA.
出版信息
J Am Soc Echocardiogr. 2007 Oct;20(10):1181-5. doi: 10.1016/j.echo.2007.02.010. Epub 2007 Jun 12.
OBJECTIVES
We sought to determine the relationship between clinical risk factors for systemic thromboembolism in patients with atrial fibrillation and the prevalence of left atrial (LA) spontaneous echocontrast (SEC) and LA thrombus (LAT).
BACKGROUND
Atrial fibrillation is associated with an increased risk of systemic thromboembolism. LA SEC and LAT also predict thromboembolic events. The relationship between clinical risk factors for systemic thromboembolism and prevalence of LA SEC and LAT is unknown.
METHODS
In all, 524 patients with atrial fibrillation underwent transesophageal echocardiography between August 2000 and March 2005. Clinical risk factors for systemic thromboembolism were determined for each patient. A CHADS(2) score ranging from 0 to 6 was calculated for each patient as: congestive heart failure = 1 point; hypertension = 1 point; age 75 years or older = 1 point; diabetes mellitus = 1 point; and history of stroke including transient ischemic attack or systemic embolism = 2 points. Transesophageal echocardiography reports were reviewed for the presence of LA SEC and LAT. Univariate and multivariable models were structured to assess which clinical risk factors predicted the presence of LA SEC or LAT.
RESULTS
In a multivariable model, age 75 years or older, previous thromboembolic event, and left ventricular ejection fraction (LVEF) less than 40% predicted LA SEC, whereas LVEF less than 40% was the only predictor of LAT. LA SEC was present in 24% of patients with a CHADS(2) score of 0, but was present in 58% with a CHADS(2) score of 5 or 6 (P < .0001). LAT was present in 3% percent of patients with a CHADS(2) score of 0, but in 17% of patients with a CHADS(2) score of 5 or 6 (P = .0026).
CONCLUSION
Age 75 years or older, previous thromboembolic event, and LVEF less than 40% predict presence of LA SEC. LVEF less than 40% is the only multivariate predictor of LAT. The prevalence of LA SEC and LAT increases with increasing CHADS(2) score.
目的
我们试图确定心房颤动患者发生系统性血栓栓塞的临床危险因素与左心房（LA）自发显影（SEC）及左心房血栓（LAT）患病率之间的关系。
背景
心房颤动与系统性血栓栓塞风险增加相关。LA SEC和LAT也可预测血栓栓塞事件。系统性血栓栓塞的临床危险因素与LA SEC及LAT患病率之间的关系尚不清楚。
方法
2000年8月至2005年3月期间，共有524例心房颤动患者接受了经食管超声心动图检查。确定每位患者发生系统性血栓栓塞的临床危险因素。为每位患者计算CHADS(2)评分，范围为0至6分：充血性心力衰竭=1分；高血压=1分；年龄≥75岁=1分；糖尿病=1分；有卒中史（包括短暂性脑缺血发作或系统性栓塞）=2分。回顾经食管超声心动图报告，了解LA SEC和LAT的存在情况。构建单变量和多变量模型，以评估哪些临床危险因素可预测LA SEC或LAT的存在。
结果
在多变量模型中，年龄≥75岁、既往血栓栓塞事件以及左心室射血分数（LVEF）<40%可预测LA SEC，而LVEF<40%是LAT的唯一预测因素。CHADS(2)评分为0的患者中LA SEC的发生率为24%，而CHADS(2)评分为5或6的患者中LA SEC的发生率为58%（P<.0001）。CHADS(2)评分为0的患者中LAT的发生率为3%，而CHADS(2)评分为5或6的患者中LAT的发生率为17%（P=.0026）。
结论
年龄≥75岁、既往血栓栓塞事件以及LVEF<40%可预测LA SEC的存在。LVEF<40%是LAT的唯一多变量预测因素。LA SEC和LAT的患病率随CHADS(2)评分的增加而升高。
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