Huang Jun, Liao Hong-Tao, Fei Hong-Wen, Xue Yu-Mei, Zhang Li, Lin Qiong-Wen, Ren Si-Qi, Zhan Xian-Zhang, Fang Xian-Hong, Zheng Mu-Rui, Wu Shu-Lin, Xu Lin
Department of Geriatrics, Guangdong General Hospital, Institute of Geriatrics, Guangdong Academy of Medical Sciences, Guangzhou, China.
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of South China Structural Heart disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Cardiology. 2018;140(2):87-95. doi: 10.1159/000489390. Epub 2018 Jun 19.
The aim of the study was to examine the association of CHADS2/CHA2DS2-VASc scores with left atrial thrombus (LAT) and spontaneous echocardiographic contrast (SEC) in non-anticoagulated nonvalvular atrial fibrillation (NVAF) spontaneous patients, and to develop a new scoring system for LAT/SEC prediction.
Consecutive non-anticoagulated NVAF patients with or without LAT/SEC by transesophageal echocardiography were identified in the Guangdong General Hospital.
Among 2,173 patients, the prevalence of LAT/SEC was 4.9%. Both predictive values of CHADS2 and CHA2DS2-VASc scores for the presence of LAT/SEC were low-to-moderate (receiver operating characteristic [ROC] = 0.591 and 0.608, respectively, p = 0.90). By multivariate analysis, non-paroxysmal AF, decreased left ventricular ejection fraction, and left atrial enlargement were positively associated with LAT/SEC, while CHADS2/CHA2DS2VASc scores were not. A new scoring system based on these 3 factors above significantly improved the discrimination for LAT/SEC (ROC = 0.792).
CHADS2/CHA2DS2-VASc scores had limited value in predicting LAT/SEC; a new scoring system that combines AF type and echocardiographic parameters may better predict LAT/SEC as a surrogate for cardioembolic risk in NVAF patients.
本研究旨在探讨非抗凝非瓣膜性心房颤动（NVAF）患者中CHADS2/CHA2DS2-VASc评分与左心房血栓（LAT）及自发超声心动图造影（SEC）之间的关联，并开发一种用于预测LAT/SEC的新评分系统。
在广东省人民医院识别出经食管超声心动图检查有无LAT/SEC的连续非抗凝NVAF患者。
在2173例患者中，LAT/SEC的患病率为4.9%。CHADS2和CHA2DS2-VASc评分对LAT/SEC存在情况的预测价值均为低到中等（受试者工作特征曲线下面积[ROC]分别为0.591和0.608，p = 0.90）。多因素分析显示，非阵发性房颤、左心室射血分数降低和左心房扩大与LAT/SEC呈正相关，而CHADS2/CHA2DS2-VASc评分则无此关联。基于上述3个因素的新评分系统显著提高了对LAT/SEC的鉴别能力（ROC = 0.792）。
CHADS2/CHA2DS2-VASc评分在预测LAT/SEC方面价值有限；一种结合房颤类型和超声心动图参数的新评分系统可能能更好地预测LAT/SEC，作为NVAF患者心脏栓塞风险的替代指标。
