Lin Wei-Dong, Xue Yu-Mei, Liu Fang-Zhou, Fang Xian-Hong, Zhan Xian-Zhang, Liao Hong-Tao, Tse Gary, Wu Shu-Lin
Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangzhou, China.
Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.
J Geriatr Cardiol. 2020 Mar;17(3):155-159. doi: 10.11909/j.issn.1671-5411.2020.03.001.
To determine the risk factors for thromboembolism in lower risk patients with non-valvular atrial fibrillation (AF) and low CHADS-VASc scores, which remain undefined.
We retrospectively analyzed the baseline clinical characteristics, routine laboratory parameters, and echocardiographic measurements of 705 patients (71.1% male; mean age: 52.10 ± 9.64 years) with low CHADS-VASc score (0 or 1; 1 point for female sex) out of 1346 consecutive patients with non-valvular AF who underwent transesophageal echocardiography (TEE) at Guangdong Cardiovascular Institute between January 2013 and December 2015.
Patients with left atrial thrombus (LAT) or spontaneous echo contrast (SEC) on TEE (24/705, 4%) showed a higher incidence rate of vascular disease (54.2% . 32.9%, = 0.045) and non-paroxysmal AF (79.2% . 29.4%, < 0.001), larger left atrial diameter (43.08 ± 4.59 . 36.02 ± 5.53 mm, < 0.001), and lower left ventricular ejection fraction (58.23 ± 8.82% . 64.15 ± 7.14%, < 0.001) than those without. Multivariate logistic regression analysis identified left atrial diameter [odds ratio (OR) = 1.171, 95% confidence interval (CI): 1.084-1.265, < 0.001] and non-paroxysmal AF (OR = 3.766, 95% CI: 1.282-11.061, = 0.016) as independent risk factors for LAT/SEC. In ROC curve analysis, a left atrial dimeter cutoff of 37.5 mm yielded 95.0% sensitivity and 62.7% specificity (AUC: 0.847, < 0.0001, 95% CI: 0.793-0.914).
In patients with non-valvular AF with low CHADS-VASc score, the presence of LAT or SEC was associated with left atrial enlargement, which had moderate predictive value, and non-paroxysmal AF.
确定低风险非瓣膜性心房颤动（AF）且CHADS-VASc评分低的患者发生血栓栓塞的危险因素，这些危险因素尚不清楚。
我们回顾性分析了2013年1月至2015年12月在广东心血管病研究所接受经食管超声心动图（TEE）检查的1346例连续性非瓣膜性AF患者中705例CHADS-VASc评分低（0或1分；女性为1分）患者的基线临床特征、常规实验室参数和超声心动图测量值。这些患者中男性占71.1%，平均年龄为52.10±9.64岁。
TEE检查发现有左心房血栓（LAT）或自发显影（SEC）的患者（24/705，4%）血管疾病发生率较高（54.2%对32.9%，P = 0.045），非阵发性AF发生率较高（79.2%对29.4%，P < 0.001），左心房直径较大（43.08±4.59mm对36.02±5.53mm，P < 0.001），左心室射血分数较低（58.23±8.82%对64.15±7.14%，P < 0.001）。多因素logistic回归分析确定左心房直径[比值比（OR）= 1.171，95%置信区间（CI）：1.084 - 1.265，P < 0.001]和非阵发性AF（OR = 3.766，95%CI：1.282 - 11.061，P = 0.016）是LAT/SEC的独立危险因素。在ROC曲线分析中，左心房直径截断值为37.5mm时，敏感性为95.0%，特异性为62.7%（曲线下面积：0.847，P < 0.0001，95%CI：0.793 - 0.914）。
在CHADS-VASc评分低的非瓣膜性AF患者中，LAT或SEC的存在与左心房扩大及非阵发性AF相关，左心房扩大具有中度预测价值。
