Department of Cardiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa street, Cerrahpasa/Fatih, 34098, Istanbul, Turkey.
Department of Radiology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Int J Cardiovasc Imaging. 2020 Jun;36(6):1097-1103. doi: 10.1007/s10554-020-01811-x. Epub 2020 Mar 5.
Ischemic stroke is the major complication of atrial fibrillation (AF) and only proven preventive therapy is oral anticoagulant therapy (OAC). Previous studies reported the presence of thrombus in the left atrium (LA) or left atrial appendage (LAA) despite anticoagulant therapy. We aim to investigate the predictors of LA/LAA thrombus in patients under OAC therapy and long-term clinical impact of thrombus. We prospectively enrolled consecutive patients with permanent AF under OAC therapy. Patients baseline characteristics were recorded. Transesophageal echocardiographic study performed after complete transthoracic echocardiographic study. 3-D evaluation of LAA was made using 3-D zoom mode and thrombus was defined when echo reflecting, mobile mass detected. Patients clinical outcomes were decided according to hospital records or via phone calls. Among 184 patients, 28 LAT were detected. Mean CHA2DS2-VASc score was significantly higher in patients with LAT in comparison to patients without LAT. CHA2DS2-VASc score (p: 0.001), left atrial volume (p: 0.001), left atrial flow velocity (p: 0.006) and left ventricular ejection fraction (p: 0.014) were independently associated with LAT. Among the parameters in CHA2DS2-VASc score, the previous history of stroke and age were independently related to LAT. After 12 months of follow-up, patients with LAT had more ischemic stroke than patients without LAT (7.1% vs 4.4%, p: 0.001 respectively). Although oral anticoagulation is the default treatment strategy for prevention of LAT and thromboembolism in patients with non-valvular AF, LAT still can be detected especially in patients with a high CHA2DS2-VASc score. Furthermore, the presence of LAT is significantly associated with future ischemic stroke.
缺血性脑卒中是心房颤动（AF）的主要并发症，只有经过证实的预防治疗方法是口服抗凝治疗（OAC）。先前的研究报告称，尽管进行了抗凝治疗，但仍存在左心房（LA）或左心耳（LAA）血栓。我们旨在研究 OAC 治疗患者中 LA/LAA 血栓的预测因素以及血栓的长期临床影响。我们前瞻性地连续招募了接受 OAC 治疗的永久性 AF 患者。记录患者的基线特征。在完全经胸超声心动图研究后进行经食管超声心动图研究。使用 3-D 缩放模式对 LAA 进行 3-D 评估，并在检测到回声反射、移动的团块时定义血栓。根据医院记录或通过电话决定患者的临床结局。在 184 例患者中，检测到 28 例 LAT。与无 LAT 的患者相比，有 LAT 的患者的平均 CHA2DS2-VASc 评分显著更高。CHA2DS2-VASc 评分（p：0.001）、左心房容积（p：0.001）、左心房流速（p：0.006）和左心室射血分数（p：0.014）与 LAT 独立相关。在 CHA2DS2-VASc 评分的参数中，既往卒中史和年龄与 LAT 独立相关。在 12 个月的随访中，有 LAT 的患者发生缺血性卒中的比例高于无 LAT 的患者（分别为 7.1%和 4.4%，p：0.001）。尽管口服抗凝是预防非瓣膜性 AF 患者 LAT 和血栓栓塞的默认治疗策略，但 LAT 仍可检测到，尤其是在 CHA2DS2-VASc 评分较高的患者中。此外，LAT 的存在与未来的缺血性卒中显著相关。
