School of Post Baccalaureate Chinese Medicine, China Medical University, Taichung, Taiwan.
Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.
Sci Rep. 2019 Nov 28;9(1):17864. doi: 10.1038/s41598-019-54505-3.
Impaired left atrial appendage ejection fraction (LAA-EF) and peak LAA flow velocity (LAA-FV) are associated with high thromboembolic risks in patients with atrial fibrillation (AF). Herein, we examined LAA function among patients with atrial flutter (AFL) stratified by the CHADS-VASc score using transesophageal echocardiography (TEE). Of 231 consecutive patients with typical AFL, 84 who fulfilled the inclusion criteria were enrolled. Among them, 57 had ongoing AFL and were divided into the isolated AFL (n = 38) and AFL with paroxysmal AF (PAF) (n = 19) groups, depending on whether they had sporadic AF before TEE. The remaining 27 patients with spontaneous sinus rhythm during TEE were designated as controls. Both the LAA-FV (31.9 cm/s vs. 51.5 cm/s, P = 0.004) and LAA-EF (28.4% vs. 36.5%, P = 0.024) measured during AFL were significantly lower in the AFL + PAF group than in the isolated AFL group. Significant inverse correlations between the CHADS-VASc score and LAA-EF were identified in the AFL (P = 0.008) and AFL + PAF (P = 0.032) groups. We observed progressive LAA dysfunction in patients with AFL + PAF compared with that in patients with isolated AFL, and the LAA-EF was inversely correlated with the CHADS-VASc score in these patients. Our findings may have implications on the application of thromboprophylactic therapy in patients with AFL.
左心耳射血分数（LAA-EF）和峰值左心耳流速（LAA-FV）降低与房颤（AF）患者的高血栓栓塞风险相关。在此，我们通过经食管超声心动图（TEE）检查了根据 CHADS-VASc 评分分层的房扑（AFL）患者的左心耳功能。在 231 例连续的典型 AFL 患者中，符合纳入标准的 84 例患者被纳入研究。其中，57 例持续发生 AFL，并根据 TEE 前是否存在阵发性 AF（PAF）分为孤立性 AFL（n = 38）和 AFL 合并阵发性 AF（n = 19）组。剩余 27 例 TEE 期间自发窦性心律的患者被指定为对照组。AFL 期间测量的 LAA-FV（31.9 cm/s 比 51.5 cm/s，P = 0.004）和 LAA-EF（28.4% 比 36.5%，P = 0.024）在 AFL 合并 PAF 组均显著低于孤立性 AFL 组。AFL（P = 0.008）和 AFL 合并 PAF（P = 0.032）组中，CHADS-VASc 评分与 LAA-EF 呈显著负相关。与孤立性 AFL 患者相比，AFL 合并 PAF 患者的左心耳功能逐渐受损，并且这些患者的 LAA-EF 与 CHADS-VASc 评分呈负相关。我们的发现可能对 AFL 患者应用抗血栓治疗具有启示意义。
