使用WATCHMAN装置经皮左心耳封堵术后血栓形成的预测因素。
Predictors of thrombus formation after percutaneous left atrial appendage closure using the WATCHMAN device.
作者信息
Kaneko Hidehiro, Neuss Michael, Weissenborn Jens, Butter Christian
机构信息
Department of Cardiology, Heart Center Brandenburg, Ladeburger Straße 17, 16321, Bernau, Germany.
Department of Cardiology, Medical School Brandenburg, Ladeburger Straße 17, 16321, Bernau, Germany.
出版信息
Heart Vessels. 2017 Sep;32(9):1137-1143. doi: 10.1007/s00380-017-0971-x. Epub 2017 May 5.
Percutaneous left atrial appendage (LAA) closure using the WATCHMAN device is a novel option for prevention of stroke associated with atrial fibrillation. However, device-related thrombus (DRT) formation is a concern after WATCHMAN implantation and the predictors of DRT still remain unclear. We aimed to clarify the predictors of DRT after WATCHMAN implantation by analyzing 78 patients (50 males, 72 ± 8 years, average CHA2DS2-VASc score of 4.3 + 1.8) who had undergone WATCHMAN implantation. WATCHMAN was successfully implanted in all patients and four (5%) developed DRT. Patients with DRT were more often female (75 vs. 34%, p = 0.094). CHA2DS2-VASc score was higher for patients with DRT (6.3 ± 2.5 vs. 4.2 ± 1.7, p = 0.022). Chronic kidney disease (100% vs. 43%, p = 0.024) and deep implantation of the device, which was defined as implant position below the LAA ostial plane (75 vs. 24%, p = 0.026), were more common in patients with DRT. HAS-BLED score (4.5 ± 1.0 vs. 3.5 ± 1.1, p = 0.074) was higher and oral anticoagulants (50 vs. 84%, p = 0.086) were less commonly prescribed for patients with DRT. Multivariable logistic regression analysis showed that higher CHA2DS2-VASc score (p = 0.022, OR 2.8) and deep implantation (p = 0.032, OR 24.7) were associated with DRT. These results suggest the possible role of CHA2S2-VASc scores and implantation depth in the development of DRT after percutaneous LAA closure using the WATCHMAN device.
使用WATCHMAN装置经皮闭合左心耳(LAA)是预防与心房颤动相关的卒中的一种新选择。然而,WATCHMAN植入术后与装置相关的血栓(DRT)形成是一个令人担忧的问题,DRT的预测因素仍不清楚。我们旨在通过分析78例接受WATCHMAN植入术的患者(50例男性,72±8岁,平均CHA2DS2-VASc评分为4.3 + 1.8)来阐明WATCHMAN植入术后DRT的预测因素。所有患者均成功植入WATCHMAN,4例(5%)发生DRT。发生DRT的患者女性更常见(75%对34%,p = 0.094)。发生DRT的患者CHA2DS2-VASc评分更高(6.3±2.5对4.2±1.7,p = 0.022)。慢性肾脏病(100%对43%,p = 0.024)以及装置的深植入(定义为植入位置低于LAA开口平面,75%对24%,p = 0.026)在发生DRT的患者中更常见。发生DRT的患者HAS-BLED评分更高(4.5±1.0对3.5±1.1,p = 0.074),口服抗凝药的处方率更低(50%对84%,p = 0.086)。多变量逻辑回归分析显示,较高的CHA2DS2-VASc评分(p = 0.022,比值比2.8)和深植入(p = 0.032,比值比24.7)与DRT相关。这些结果提示CHA2S2-VASc评分和植入深度在使用WATCHMAN装置经皮LAA闭合术后DRT形成中可能起的作用。