Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No 2 Anzhen Road, Chaoyang District, Beijing, People's Republic of China.
Center for coronary heart disease, Department of Cardiology, Cardiovascular Institute & Fuwai Hospital, CAMS & PUMC, National Center for Heart Disease, No 167 Beilishi Road, Xicheng District, Beijing, P. R. China.
Europace. 2018 Jul 1;20(7):1093-1098. doi: 10.1093/europace/eux189.
To assess the association and the predictive value of plasma homocysteine (Hcy) levels with LA/LAA thrombus in non-valvular Atrial fibrillation (AF) patients with low CHA2DS2-VASc score.
Eight hundred and eighty-eight consecutive patients in non-valvular AF with CHA2DS2-VASc score of 0 and 1 were enrolled. All patients routinely underwent transthoracic echocardiography and transoesophageal echocardiography. A total of thirty-two patients had LA/LAA thrombus. Compared with patients without LA/LAA thrombus, plasma Hcy levels were significantly higher in patients with LA/LAA thrombus (16.5 ± 4.8 mmol/L vs. 13.4 ± 4.1 mmol/L, P = 0.009). In multivariate analysis, Hcy was independently associated with LA/LAA thrombus (OR 1.048, 95% CI 1.007-1.090, P = 0.022). Hcy demonstrated a significant predictive value with area under the curve of 0.722 (95% CI 0.662-0.781, P < 0.001). The optimal cut-off point for Hcy predicting LA/LAA thrombus was 13.5 mmol/L (sensitivity 67%, specificity 65%). Patients with Hcy ≥13.5 mmol/L had higher prevalence of LA/LAA thrombus compared with those with Hcy <13.5 mmol/L (6.1% vs. 2.1%, P < 0.001). Elevated Hcy significantly increased the risk of LA/LAA thrombus in patients with CHA2DS2-VASc score of 0 and 1 (OR 11.789, 95% CI 1.437-96.746, P = 0.022; OR 2.256, 95% CI 1.007-5.155, P = 0.048, respectively).
Elevated plasma Hcy increases the risk of LA/LAA thrombus in non-valvular AF patients with low CHA2DS2-VASc score, thus it should be taken into account in prediction of thromboembolism.
评估非瓣膜性心房颤动（AF）低 CHA2DS2-VASc 评分患者的血浆同型半胱氨酸（Hcy）水平与左心耳（LA）/左心房间（LAA）血栓之间的相关性及其预测价值。
连续纳入 888 例非瓣膜性 AF 且 CHA2DS2-VASc 评分为 0 或 1 的患者。所有患者均常规行经胸超声心动图和经食管超声心动图检查。共有 32 例患者存在 LA/LAA 血栓。与无 LA/LAA 血栓的患者相比，有 LA/LAA 血栓的患者的血浆 Hcy 水平显著升高（16.5±4.8mmol/L 比 13.4±4.1mmol/L，P=0.009）。多因素分析显示，Hcy 与 LA/LAA 血栓独立相关（OR 1.048，95%CI 1.007-1.090，P=0.022）。Hcy 的曲线下面积为 0.722（95%CI 0.662-0.781，P<0.001），具有显著的预测价值。Hcy 预测 LA/LAA 血栓的最佳截断值为 13.5mmol/L（敏感性 67%，特异性 65%）。Hcy≥13.5mmol/L 的患者 LA/LAA 血栓的发生率高于 Hcy<13.5mmol/L 的患者（6.1%比 2.1%，P<0.001）。在 CHA2DS2-VASc 评分为 0 和 1 的患者中，升高的 Hcy 显著增加了 LA/LAA 血栓的风险（OR 11.789，95%CI 1.437-96.746，P=0.022；OR 2.256，95%CI 1.007-5.155，P=0.048）。
升高的血浆 Hcy 增加了低 CHA2DS2-VASc 评分的非瓣膜性 AF 患者发生 LA/LAA 血栓的风险，因此在血栓栓塞预测中应考虑到这一点。
