计划进行心脏复律的持续性心房颤动患者在接受适当抗凝治疗后经食管超声心动图检查结果
Findings of transoesophageal echocardiogram in appropriately anticoagulated patients with persistent atrial fibrillation prior to planned cardioversion.
作者信息
Barysienė Jūratė, Žebrauskaitė Aistė, Petrikonytė Dovilė, Marinskis Germanas, Aidietienė Sigita, Aidietis Audrius
机构信息
Centre of Cardiology and Angiology, Vilnius University Hospital Santariskiu Clinics, 2 Santariškių St., LT -08661, Vilnius, Lithuania.
Clinic of Cardiovascular Diseases, Faculty of Medicine, Vilnius University, 21 Čiurlionio St., LT-03101, Vilnius, Lithuania.
出版信息
BMC Cardiovasc Disord. 2017 Feb 23;17(1):67. doi: 10.1186/s12872-017-0503-8.
BACKGROUND
To evaluate a diagnostic value of transoesophageal echocardiogram (TEE) in appropriately anticoagulated patients with a non-valvular atrial fibrillation (AF) and to establish possible additional indications for TEE; to evaluate the incidence of left atrial (LA) thrombi in appropriately anticoagulated patients in daily clinical practice.
METHODS
This retrospective study analyses data of 432 patients who had been anticoagulated by means of oral anticoagulants (OACs) prior to planned cardioversion during the period from 2012 to 2015. Thromboembolic (TE) and bleeding risks were assessed using CHA2DS2-VASc and HAS-BLED scores. Transthoracic and transoesophageal echocardiograms were evaluated. TE complications during 30 days after discharge were assessed.
RESULTS
432 patients were selected, aged from 22 to 89 years (mean 65.0 ±11.5), 277 (64.1%) males and 155 (35.9%) females, 306 (70.8%) on warfarin and 126 (29.2%) on non-vitamin K antagonist oral anticoagulants (NOAC). Mean CHA2DS2-VASc score was 3.5 ±1.5. TEE was performed for 120 (27.8%) patients, more frequently for patients on NOACs and for ones with III° LA enlargement. TEE revealed LA thrombi in seven (5.8%) of the patients. In warfarin and NOACs groups thrombi were revealed in five (7.0%) and two (4.1%) patients, respectively. TEE did not reveal any thrombi in patients with normal left ventricular (LV) function; however, thrombi were found in two (6.1%) patients with slightly decreased LV function, and in five (17.9%) patients with markedly decreased LV function. In patients with decreased left ventricular ejection fraction (LVEF) thrombi in LA were found more frequently than in patients with normal and slightly decreased LVEF (17.9% vs 2.2%, p=0.008). CHA2DS2-VASc score of all 7 patients was ≥5. None of the patients after cardioversion had TE complications 30 days after discharge.
CONCLUSIONS
The risk of LA thrombi in patients prepared for scheduled cardioversion in line with the guidelines is low. Higher risk of thrombi was present in patients with decreased LVEF (≤40%), CHA2DS2-VASc ≥5. In order to assess more accurately indications to perform TEE for appropriately anticoagulated patients prior to scheduled cardioversion a study with larger number of patients is required.
背景
评估经食管超声心动图（TEE）在适当抗凝的非瓣膜性心房颤动（AF）患者中的诊断价值，并确定TEE可能的其他适应证；评估日常临床实践中适当抗凝患者左心房（LA）血栓的发生率。
方法
这项回顾性研究分析了2012年至2015年期间432例计划复律前接受口服抗凝剂（OAC）抗凝治疗的患者的数据。使用CHA2DS2-VASc和HAS-BLED评分评估血栓栓塞（TE）和出血风险。对经胸和经食管超声心动图进行评估。评估出院后30天内的TE并发症。
结果
共入选432例患者，年龄22至89岁（平均65.0±11.5岁），男性277例（64.1%），女性155例（35.9%），306例（70.8%）服用华法林，126例（29.2%）服用非维生素K拮抗剂口服抗凝剂（NOAC）。平均CHA2DS2-VASc评分为3.5±1.5。120例（27.8%）患者接受了TEE检查，服用NOAC的患者以及左心房Ⅲ°扩大的患者接受TEE检查更为频繁。TEE在7例（5.8%）患者中发现了左心房血栓。在华法林组和NOAC组中，分别有5例（7.0%）和2例（4.1%）患者发现血栓。左心室（LV）功能正常的患者中TEE未发现任何血栓；然而，在2例（6.1%）左心室功能轻度下降的患者和5例（17.9%）左心室功能明显下降的患者中发现了血栓。左心室射血分数（LVEF）降低的患者左心房血栓的发生率高于LVEF正常和轻度降低的患者（17.9%对2.2%，p=0.008）。所有7例患者的CHA2DS2-VASc评分均≥5。复律后所有患者出院后30天内均未发生TE并发症。
结论
按照指南准备进行计划性复律的患者发生左心房血栓的风险较低。LVEF降低（≤40%）、CHA2DS2-VASc≥5的患者血栓风险较高。为了更准确地评估适当抗凝患者在计划性复律前进行TEE检查的适应证，需要进行更大规模的患者研究。
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