Hrynkiewicz-Szymanska Anna, Dluzniewski Miroslaw, Platek Anna E, Szymanski Filip M, Syska-Suminska Joanna, Klos-Szadryn Agnieszka, Glinka Marta, Strojek Malgorzata, Kuciej Alicja, Tomaszewska-Kiecana Monika
Department of Cardiology, Hypertension and Internal Diseases, Medical University of Warsaw, Kondratowicza 8 Street, 03-242, Warsaw, Poland,
J Thromb Thrombolysis. 2015 Aug;40(2):240-7. doi: 10.1007/s11239-014-1154-6.
Assessment of thromboembolic risk is crucial for proper management of atrial fibrillation (AF) patients. Currently used risk score base only on scarce clinical data and do not take into consideration parameters including echocardiographic findings. The aim of this study was to evaluate if left atrium (LA) enlargement is associated with higher thromboembolic risk assessed by CHADS2 and CHA2DS2-VASc scores in a cohort of unselected non-valvular AF patients. Data from 582 AF hospitalizations occurring between November 2012 and January 2014 were analyzed. All patients underwent a standard transthoracic echocardiography and had their thromboembolic risk assessed in both CHADS2 and CHA2DS2-VASc scores. In 494 enrolled patients (48.5 % male; mean age 73.4 ± 11.5 years) AF was classified as paroxysmal in 233 (47.3 %), as persistent in 109 (22.1 %), and as permanent in 151 (30.6 %) patients. LA was enlarged in 426 (86.2 %) patients. Enlargement was classified as mild in 99 (20.0 %) patients, as moderate in 130 (26.3 %) patients, and as severe in 196 (39.7 %) patients. Patients with enlarged LA had higher mean CHADS2 score (2.0 ± 1.5 vs. 2.6 ± 1.3; p = 0.0005) and CHA2DS2-VASc (3.8 ± 2.0 vs. 4.4 ± 1.8; p = 0.02) score than patients with normal LA. The both mean scores rose along with rising LA diameter. LA enlargement is highly prevalent in AF patients. Higher thromboembolic risk assessed by both CHADS2 and CHA2DS2-VASc scores is associated with presence of LA enlargement. Echocardiographically assessed LA size may be an additional parameter useful in thromboembolic risk stratification of AF patients.
评估血栓栓塞风险对于心房颤动（AF）患者的合理管理至关重要。目前使用的风险评分仅基于稀少的临床数据，未考虑包括超声心动图检查结果等参数。本研究的目的是评估在一组未经选择的非瓣膜性AF患者中，左心房（LA）扩大是否与通过CHADS2和CHA2DS2-VASc评分评估的较高血栓栓塞风险相关。分析了2012年11月至2014年1月期间发生的582例AF住院患者的数据。所有患者均接受了标准经胸超声心动图检查，并通过CHADS2和CHA2DS2-VASc评分评估了他们的血栓栓塞风险。在494例入选患者中（男性48.5%；平均年龄73.4±11.5岁），AF分类为阵发性的有233例（47.3%），持续性的有109例（22.1%），永久性的有151例（30.6%）。426例（86.2%）患者存在LA扩大。扩大分类为轻度的有99例（20.0%）患者，中度的有130例（26.3%）患者，重度的有196例（39.7%）患者。LA扩大的患者比LA正常的患者具有更高的平均CHADS2评分（2.0±1.5对2.6±1.3；p = 0.0005）和CHA2DS2-VASc评分（3.8±2.0对4.4±1.8；p = 0.02）。两个平均评分均随LA直径增加而升高。LA扩大在AF患者中非常普遍。通过CHADS2和CHA2DS2-VASc评分评估的较高血栓栓塞风险与LA扩大的存在相关。超声心动图评估的LA大小可能是用于AF患者血栓栓塞风险分层的一个额外有用参数。
