Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.
Asklepios Hospital St. Georg, Hamburg, Germany.
Clin Appl Thromb Hemost. 2021 Jan-Dec;27:10760296211021171. doi: 10.1177/10760296211021171.
Left atrial (LA) thrombus formation is the presumed origin of thromboembolic complications in patients with atrial fibrillation (AF). Beyond clinical risk factors, the factors causing formation of LA thrombi are not well known. In this case-control study, we analyzed clinical characteristics and genetic thrombophilia markers (factor V Leiden (FVL), prothrombin G20210A (FIIV), Tyr2561 variant of von Willebrand factor (VWF-V)) in 42 patients with AF and LA thrombus (LAT) and in 68 control patients with AF without LAT (CTR). Patients with LAT had more clinical conditions predisposing to stroke (mean CHADS-VASc-score 3.4 ± 1.5 vs. 1.9 ± 1.4; < 0.001), a higher LA volume (96 ± 32 vs. 76 ± 21 ml, = 0.002) and lower LA appendage emptying velocity (0.21 ± 0.11vs. 0.43 ± 0.19 m/s, < 0.001). Prevalence of FVL, FIIV and VWF-V mutations was not different, but in the subgroup of patients <65 years (y) there was a tendency for a higher incidence of VWF-V with a prevalence of 27% (LAT <65 y) vs. 7% (CTR <65 y, = 0.066). These findings warrant further investigation of the VWF-V as a risk factor for LA thrombogenesis in younger patients.
左心房（LA）血栓形成是心房颤动（AF）患者血栓栓塞并发症的推测来源。除了临床危险因素外，导致 LA 血栓形成的因素尚不清楚。在这项病例对照研究中，我们分析了 42 例 AF 合并 LA 血栓形成（LAT）患者和 68 例无 LAT 的 AF 对照患者（CTR）的临床特征和遗传血栓形成倾向标志物（因子 V 莱顿突变（FVL）、凝血酶原 G20210A 突变（FIIV）、血管性血友病因子 Tyr2561 变异体（VWF-V））。LAT 患者具有更多导致中风的临床疾病（平均 CHADS-VASc 评分 3.4 ± 1.5 比 1.9 ± 1.4；<0.001）、更大的 LA 容积（96 ± 32 比 76 ± 21 ml，=0.002）和更低的 LA 心耳排空速度（0.21 ± 0.11 比 0.43 ± 0.19 m/s，<0.001）。FVL、FIIV 和 VWF-V 突变的发生率没有差异，但在<65 岁的患者亚组中，VWF-V 的发生率有升高的趋势，其发生率为 27%（LAT <65 岁）比 7%（CTR <65 岁，=0.066）。这些发现提示进一步研究 VWF-V 作为年轻患者 LA 血栓形成的危险因素。
