Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California 90502.
Tex Heart Inst J. 2020 Apr 1;47(2):78-85. doi: 10.14503/THIJ-17-6290.
Assessing thromboembolic risk is crucial for proper management of patients with atrial fibrillation. Left atrial volume is a promising predictor of cardiac thrombosis. To determine whether left atrial volume can predict left atrial appendage thrombus in patients with atrial fibrillation, we conducted a prospective study of 73 patients. Left atrial and ventricular volumes were evaluated by cardiac computed tomography with retrospective electrocardiographic gating and then indexed to body surface area. Left atrial appendage thrombus was confirmed or excluded by cardiac computed tomography with delayed enhancement. Seven patients (9.6%) had left atrial appendage thrombus; 66 (90.4%) did not. Those with thrombus had a significantly higher mean left atrial end-systolic volume index (139 ± 55 vs 101 ± 35 mL/m2; P =0.0097) and mean left atrial end-diastolic volume index (122 ± 45 vs 84 ± 34 mL/m2; P =0.0077). On multivariate logistic regression analysis, left atrial end-systolic volume index (per 10 mL/m2 increase) was significantly associated with left atrial appendage thrombus (odds ratio [OR]=1.24; 95% CI, 1.03-1.50; P =0.02); so too was the left atrial end-diastolic volume index (per 10 mL/m2 increase) (OR=1.29; 95% CI, 1.05-1.60; P =0.02). These findings suggest that increased left atrial volume increases the risk of left atrial appendage thrombus. Therefore, patients with atrial fibrillation and an enlarged left atrium should be considered for cardiac computed tomography with delayed enhancement to confirm whether thrombus is present.
评估血栓栓塞风险对于心房颤动患者的合理管理至关重要。左心房容积是预测心脏血栓形成的有前途的指标。为了确定左心房容积是否可以预测心房颤动患者的左心耳血栓，我们对 73 例患者进行了前瞻性研究。通过回顾性心电图门控心脏计算机断层扫描评估左心房和心室容积，然后将其指数化到体表面积。通过心脏计算机断层扫描延迟增强来确认或排除左心耳血栓。7 例（9.6%）患者存在左心耳血栓；66 例（90.4%）患者无血栓。有血栓的患者左心房收缩末期容积指数（139 ± 55 比 101 ± 35 mL/m2；P=0.0097）和左心房舒张末期容积指数（122 ± 45 比 84 ± 34 mL/m2；P=0.0077）明显更高。多变量逻辑回归分析显示，左心房收缩末期容积指数（每增加 10 mL/m2）与左心耳血栓显著相关（比值比[OR]=1.24；95%置信区间，1.03-1.50；P=0.02）；左心房舒张末期容积指数（每增加 10 mL/m2）也是如此（OR=1.29；95%置信区间，1.05-1.60；P=0.02）。这些发现表明，左心房容积增加会增加左心耳血栓形成的风险。因此，对于心房颤动和左心房扩大的患者，应考虑进行心脏计算机断层扫描延迟增强以确认是否存在血栓。
