Lu Ming-jun, Wu Shu-lin, Xue Yu-mei, Liao Lu-ming, Huang Jun, Yang Ping-zhen, Zhan Xian-zhang
Guangdong Cardiovascular Institute, Department of Cardiology of Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510010, China.
Zhonghua Yi Xue Za Zhi. 2009 Dec 1;89(44):3135-7.
To determine the predictors of thrombosis in left atrium (LA) or left atrial appendage (LAA) in patients with nonvalvular atrial fibrillation.
Two hundred and eight patients under 65 year old with atrial fibrillation (AF) were included and all of them received examination of transesophageal echocardiography (TEE). Thrombus formation in LA/LAA was found in 23 patients (thrombus group) but absent in the remaining 185 patients (nonthrombus group). All patients were analyzed by univariate regression and binary logistic regression to investigate the relationship between the occurrence of LA/LAA thrombosis and these factors (such as case history, smoking/drinking preference, indicators of clinical blood examination and ultrasound imaging study, etc)
Univariate analysis revealed that diameter of LA [(34.9 +/- 4.4) mm vs (42.2 +/- 6.5) mm, P = 0.000], ratio of chest and heart (60/185 vs 20/23 P = 0.000), brain infarction/transient ischemic attack (TAI) (7/185 vs 6/23 P = 0.000), smoking (30/185 vs 8/23, P = 0.030), fibrinogen (FIB) [(3.0 +/- 0.7)g/L vs (3.5 +/- 1.0) g/L, P = 0.000], coronary artery disease (CAD) (10/185 vs 6/23, P = 0.000) and LVDd [(45.7 +/- 4.1) mm vs (48.5 +/- 5.7) mm, P = 0.000] and LVEF [(65.1 +/- 6.6) mm vs (59.3 +/- 1.3) mm, P = 0.050] were significant between nonthrombus group and thrombus group (P < 0.05). However binary logistic regression analysis identified that only LAD, ratio of chest and heart, brain infarction/TAI and FIB were the significant and independent predictors of LA/LAA thrombosis.
Diameter of LA, ratio of chest and heart, brain infarction/TAI and FIB are independent risk factors of thrombosis in patients under 65 year old with nonvalvular atrial fibrillation. These patients need a better anticoagulation.
确定非瓣膜性心房颤动患者左心房（LA）或左心耳（LAA）血栓形成的预测因素。
纳入208例65岁以下的心房颤动（AF）患者，所有患者均接受经食管超声心动图（TEE）检查。23例患者（血栓组）发现LA/LAA有血栓形成，其余185例患者（无血栓组）未发现。对所有患者进行单因素回归分析和二元逻辑回归分析，以探讨LA/LAA血栓形成的发生与这些因素（如病史、吸烟/饮酒偏好、临床血液检查指标和超声影像学研究等）之间的关系。
单因素分析显示，非血栓组和血栓组之间LA直径[（34.9±4.4）mm对（42.2±6.5）mm，P = 0.000]、心胸比（60/185对20/23，P = 0.000）、脑梗死/短暂性脑缺血发作（TAI）（7/185对6/23，P = 0.000）、吸烟（30/185对8/23，P = 0.030）、纤维蛋白原（FIB）[（3.0±0.7）g/L对（3.5±1.0）g/L，P = 0.000]、冠状动脉疾病（CAD）（10/185对6/23，P = 0.000）以及左室舒张末期内径[（45.7±4.1）mm对（48.5±5.7）mm，P = 0.000]和左室射血分数[（65.1±6.6）mm对（59.3±1.3）mm，P = 0.050]差异有统计学意义（P < 0.05）。然而，二元逻辑回归分析确定只有LA直径、心胸比、脑梗死/TAI和FIB是LA/LAA血栓形成的显著且独立的预测因素。
LA直径、心胸比、脑梗死/TAI和FIB是65岁以下非瓣膜性心房颤动患者血栓形成的独立危险因素。这些患者需要更好的抗凝治疗。
