经食管超声心动图检查证实的伴有和不伴有左心房血栓的心房颤动患者的血栓栓塞。

Thromboembolism in patients with atrial fibrillation with and without left atrial thrombus documented by transesophageal echocardiography.

机构信息

Cardiac Center, Creighton University, Omaha, NE, USA.

出版信息

Am J Ther. 2009 Sep-Oct;16(5):385-92. doi: 10.1097/MJT.0b013e3181727b42.

PMID:19955857

Abstract

The incidence of cerebrovascular events (CVEs) was investigated in 95 consecutive patients with atrial fibrillation (AF) with left atrial thrombus (LAT) diagnosed by transesophageal echocardiography (TEE) and in 131 age- and sex-matched AF patients without LAT. Compared with patients without LAT, patients with LAT had a larger left atrial diameter (49 versus 44 mm, P < 0.0001), a lower left ventricular ejection fraction (40% versus 50%, P < 0.0001), a higher prevalence of spontaneous echocardiographic contrast (88% versus 25%, P < 0.001), a reduced left atrial appendage emptying velocity (0.25 versus 0.41 cm/s, P < 0.0001), and less use of antiarrhythmic drugs (61% versus 76%, P = 0.03). Before TEE, the prevalence of prior CVE was higher in LAT patients (20%) compared with patients without LAT (8%) (P = 0.01). Fifty-four of 95 LAT patients (57%) and 81 of 131 non-LAT patients (62%) were on warfarin before TEE. The incidence of prior CVE in LAT patients without warfarin (32%) was higher than that in non-LAT patients without warfarin (10%) (P = 0.02). The mortality rate in LAT patients with an international normalized ratio (INR) >or= 2.0 (42%) was higher than that in patients without LAT and an INR >or= 2.0 (11%) (P < 0.001). Fifty-one of 95 LAT patients (54%) underwent repeat TEE before cardioversion (48 patients received warfarin therapy). The thrombus resolved in 40 of 51 patients (78%) after the first TEE. There was no significant difference in INR between the patients with persistent and resolved LAT. AF patients with persistent LAT had a higher incidence of CVE (45%) than the patients with resolved LAT (5%) (P = 0.003). We suggest that patients with LAT be treated with warfarin to maintain an INR between 2.5 and 3.5 rather than between 2.0 and 3.0 because they are at a high risk for new thromboembolism.

摘要

本研究调查了 95 例经食管超声心动图（TEE）诊断为左心房血栓（LAT）的持续性心房颤动（AF）患者和 131 例年龄和性别相匹配的无 LAT 的 AF 患者的脑血管事件（CVE）发生率。与无 LAT 的患者相比，LAT 患者的左心房直径更大（49 毫米比 44 毫米，P < 0.0001），左心室射血分数更低（40%比 50%，P < 0.0001），自发性超声对比的发生率更高（88%比 25%，P < 0.001），左心耳排空速度更低（0.25 厘米/秒比 0.41 厘米/秒，P < 0.0001），抗心律失常药物的使用率更低（61%比 76%，P = 0.03）。TEE 前，LAT 患者（20%）的既往 CVE 发生率高于无 LAT 患者（8%）（P = 0.01）。95 例 LAT 患者中，54 例（57%）和 131 例非 LAT 患者中，81 例（62%）在 TEE 前服用华法林。未服用华法林的 LAT 患者（32%）的既往 CVE 发生率高于未服用华法林的非 LAT 患者（10%）（P = 0.02）。INR >或= 2.0 的 LAT 患者的死亡率（42%）高于无 LAT 且 INR >或= 2.0 的患者（11%）（P < 0.001）。95 例 LAT 患者中有 51 例（54%）在电复律前接受了重复 TEE（48 例接受了华法林治疗）。首次 TEE 后，51 例患者中有 40 例（78%）血栓溶解。持续 LAT 患者和已溶解 LAT 患者的 INR 无显著差异。持续性 LAT 的 AF 患者的 CVE 发生率（45%）高于已溶解 LAT 的患者（5%）（P = 0.003）。我们建议 LAT 患者的 INR 维持在 2.5 到 3.5 之间，而不是 2.0 到 3.0 之间，因为他们有发生新血栓栓塞的高风险。