Liu Yaowu, Zhu Didi, Xiao Yunyun, Zhu Yeqian, Zhou Qianxing, Ren Liqun, Chen Long
Department of Cardiology, Zhongda Hospital of Southeast University, Nanjing, 210009, China.
Department of Geriatrics, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210008, China.
Open Med (Wars). 2021 Mar 3;16(1):361-366. doi: 10.1515/med-2021-0009. eCollection 2021.
To investigate the risk factors of left atrial appendage thrombus (LAAT) in patients with non-valvular atrial fibrillation (AF).
We collected the clinical data of patients with non-valvular AF who underwent transesophageal echocardiography (TEE) at the Zhongda Hospital of Southeast University between January 2016 and June 2019. The patients were divided into two groups, LAAT and non-LAAT. We performed comparative analysis, receiver operating characteristic (ROC) curve analysis and logistic regression analysis to estimate the risk factors of LAAT.
A total of 442 patients with non-valvular AF were enrolled in the study. LAAT was detected by TEE in 20 cases (4.7%). Compared with patients without LAAT, patients with LAAT had higher CHADS-VASc scores (3 vs 2, = 0.001), higher values of D-dimer (180.0 vs 90.0 μg/L, = 0.003), larger LA anteroposterior diameters (50.5 vs 41.0 mm, < 0.001) and higher ratios of non-paroxysmal AF (85.0% vs 23.6%, < 0.001). ROC curve analysis revealed that the cutoff value of LA anteroposterior diameter was 49.5 mm. After adjusting for other confounders, logistic regression analysis showed that enlarged LA (anteroposterior diameter ≥49.5 mm) and non-paroxysmal AF were independently associated with higher risks of LAAT (OR = 7.28, 95% CI: 2.36-22.47; OR = 8.89, 95% CI: 2.33-33.99, respectively). The proportions of LAAT in patients with larger LA (anteroposterior diameter ≥49.5 mm), non-paroxysmal AF and both larger LA and non-paroxysmal AF were 30% (12/40), 15.2% (17/112) and 39.1% (9/23), respectively.
Enlarged LA (anteroposterior diameter ≥49.5 mm) and non-paroxysmal AF were independent risk factors of LAAT in non-valvular AF patients.
探讨非瓣膜性心房颤动（AF）患者左心耳血栓（LAAT）的危险因素。
收集2016年1月至2019年6月在东南大学附属中大医院接受经食管超声心动图（TEE）检查的非瓣膜性AF患者的临床资料。将患者分为两组，即LAAT组和非LAAT组。我们进行了对比分析、受试者工作特征（ROC）曲线分析和逻辑回归分析，以评估LAAT的危险因素。
本研究共纳入442例非瓣膜性AF患者。TEE检测到20例（4.7%）LAAT。与无LAAT的患者相比，LAAT患者的CHADS-VASc评分更高（3分对2分，P = 0.001），D-二聚体值更高（180.0对90.0μg/L，P = 0.003），左房前后径更大（50.5对41.0mm，P < 0.001），非阵发性AF的比例更高（85.0%对23.6%，P < 0.001）。ROC曲线分析显示，左房前后径的截断值为49.5mm。在调整其他混杂因素后，逻辑回归分析显示，左房扩大（前后径≥49.5mm）和非阵发性AF与LAAT的较高风险独立相关（OR分别为7.28，95%CI：2.36 - 22.47；OR为8.89，95%CI：2.33 - 33.99）。左房扩大（前后径≥49.5mm）、非阵发性AF以及左房扩大合并非阵发性AF的患者中LAAT的比例分别为30%（12/40）、15.2%（17/112）和39.1%（9/23）。
左房扩大（前后径≥49.5mm）和非阵发性AF是非瓣膜性AF患者LAAT独立的危险因素。
