Zhou Xiaodong, Shi Ruiyu, Wu Gaojun, Zhu Qianli, Zhou Changzuan, Wang Liangguo, Xue Chenglong, Jiang Yuanyuan, Cai Xueli, Huang Weijian, Shan Peiren
Department of Cardiology, The Key Laboratory of Cardiovascular Disease of Wenzhou, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, Zhejiang, 325000, China.
Department of Cardiology, Longgang City People's Hospital, Longgang, Zhejiang, China.
ESC Heart Fail. 2021 Apr;8(2):1284-1294. doi: 10.1002/ehf2.13196. Epub 2021 Jan 25.
This study aimed to determine prevalence, predictors, and association with ischaemic stroke risk of spontaneous echocardiographic contrast (SEC) or left ventricular thrombus (LVT) in patients with heart failure with reduced ejection fraction (HFrEF).
Clinical, echocardiographic, and follow-up data from January 2009 through February 2019 were retrospectively extracted from electronic medical records of patients with heart failure with left ventricular ejection fraction < 40% by echocardiography on admission, with follow-up to February 2020. Of 9485 consecutive patients with HFrEF, 123 (1.3%) presented LVT and 331 (3.5%) presented SEC. Patients with vs. those without SEC/LVT had larger left ventricular end-diastolic volume (199.5 ± 77.7 vs. 165.8 ± 61.3 mL, P < 0.001), lower left ventricular ejection fractions (29.5 ± 7.0% vs. 33.7 ± 5.5%, P < 0.001), and more often ischaemic cardiomyopathy, apical aneurysm, chronic kidney diseases, and smoking habit. In Cox regression analysis, SEC and LVT were independent predictors for ischaemic stroke occurrence [hazard ratio (HR) = 2.40, 95% confidence interval (CI): 1.74-3.31; HR = 4.52, 95% CI: 2.77-7.40, both P < 0.001]. In patients with those without SEC or LVT, stroke risk was higher among those not on anticoagulants (HR = 2.55, 95% CI: 1.85-3.53; HR = 4.71, 95% CI: 2.84-7.81, both P < 0.001), but similar among those on anticoagulants (P > 0.05). In patients with sinus rhythm, the associations between SEC/LVT and ischaemic stroke persist with HRs of 2.57 (95% CI: 1.69-3.92) and 5.74 (95% CI: 3.38-9.75).
In patients with HFrEF, SEC was not uncommon and increased risk of ischaemic stroke as well as LVT. Anticoagulants could play a role in the reduction of stroke risk, suggesting that patients with SEC/LVT, even those in sinus rhythm, would benefit from systemic anticoagulation treatment.
本研究旨在确定射血分数降低的心力衰竭（HFrEF）患者中，自发超声心动图造影（SEC）或左心室血栓（LVT）的患病率、预测因素及其与缺血性中风风险的关联。
回顾性提取2009年1月至2019年2月期间，入院时经超声心动图检查左心室射血分数<40%的心力衰竭患者的临床、超声心动图及随访数据，随访至2020年2月。在9485例连续的HFrEF患者中，123例（1.3%）出现LVT，331例（3.5%）出现SEC。有SEC/LVT的患者与无SEC/LVT的患者相比，左心室舒张末期容积更大（199.5±77.7 vs. 165.8±61.3 mL，P<0.001），左心室射血分数更低（29.5±7.0% vs. 33.7±5.5%，P<0.001），且缺血性心肌病、心尖部动脉瘤、慢性肾脏病及吸烟习惯更为常见。在Cox回归分析中，SEC和LVT是缺血性中风发生的独立预测因素[风险比（HR）=2.40，95%置信区间（CI）：1.74-3.31；HR=4.52，95%CI：2.77-7.40，P均<0.001]。在无SEC或LVT的患者中，未接受抗凝治疗者的中风风险更高（HR=2.55，95%CI：1.85-3.53；HR=4.71，95%CI：2.84-7.81，P均<0.001），但接受抗凝治疗者的中风风险相似（P>0.05）。在窦性心律患者中，SEC/LVT与缺血性中风之间的关联持续存在，HR分别为2.57（95%CI：1.69-3.92）和5.74（95%CI：3.38-9.75）。
在HFrEF患者中，SEC并不少见，且会增加缺血性中风风险以及LVT的发生风险。抗凝治疗可降低中风风险，提示有SEC/LVT的患者，即使是窦性心律患者，也将从全身抗凝治疗中获益。
