Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland.
1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
Cardiovasc Ther. 2020 Apr 24;2020:3501749. doi: 10.1155/2020/3501749. eCollection 2020.
Atrial fibrillation (AF) is associated with high risk of ischemic stroke. The most frequent thrombus location in AF is the left atrial appendage (LAA). Transthoracic echocardiography (TTE) is a basic diagnostic examination in patients (pts) with AF.
To analyse the relations between basic echocardiographic features, well-established stroke risk factors, type of AF, and anticoagulation therapy with the incidence of left atrial appendage thrombus (LAAT). . The study group consisted of 768 pts with AF (mean age, 63 years), admitted to three high-reference cardiology departments. Five hundred and twenty-three pts were treated with non-vitamin K antagonist oral anticoagulants (NOACs) and 227 (30%) with vitamin K antagonists (VKAs). The subjects underwent TTE and transesophageal echocardiography (TEE) before cardioversion or ablation.
LAAT was significantly more frequent in pts with reduced left ventricular ejection fraction (LVEF): in 10.6% (7 pts) with LVEF < 40% and in 9.0% (9 pts) with LVEF 40-49%, while only in 5.5% (33 pts) with LVEF > 50%. Compared to pts without LAAT, those with LAAT presented with lower LVEF and higher left atrial diameter (LAD). Multivariate logistic regression revealed the following variables as independent predictors of LAAT: previous bleeding, treatment with VKA, and LVEF.
LAAT is related to lower LVEF and higher LAD. LVEF is one of the independent predictors of LAAT. Even in the case of adequate anticoagulant therapy, it might be prudent to consider TEE before cardioversion or ablation in patients with low LVEF and LA enlargement, especially in the coexistence of other thromboembolic risk factors.
心房颤动（AF）与缺血性中风的风险增加相关。AF 中最常见的血栓部位是左心耳（LAA）。经胸超声心动图（TTE）是 AF 患者的基本诊断检查。
分析基本超声心动图特征、已确立的中风危险因素、AF 类型和抗凝治疗与左心耳血栓（LAAT）发生率之间的关系。该研究组包括 768 名 AF（平均年龄 63 岁）患者，他们被收入三个高参考心内科。523 名患者接受了非维生素 K 拮抗剂口服抗凝剂（NOACs）治疗，227 名（30%）接受了维生素 K 拮抗剂（VKAs）治疗。患者在电复律或消融前接受了 TTE 和经食管超声心动图（TEE）检查。
左心室射血分数（LVEF）降低的患者中 LAAT 更为常见：LVEF < 40%的患者中有 10.6%（7 例），LVEF 为 40-49%的患者中有 9.0%（9 例），而 LVEF > 50%的患者中只有 5.5%（33 例）。与无 LAAT 的患者相比，LAAT 患者的 LVEF 较低，左心房直径（LAD）较高。多变量逻辑回归显示，LAAT 的独立预测因子包括：既往出血、VKA 治疗和 LVEF。
LAAT 与较低的 LVEF 和较高的 LAD 相关。LVEF 是 LAAT 的独立预测因子之一。即使在充分抗凝治疗的情况下，对于 LVEF 较低和左心房扩大的患者，特别是在存在其他血栓栓塞危险因素的情况下，在电复律或消融前考虑 TEE 可能是谨慎的做法。
