Kosmalska Katarzyna, Gilis-Malinowska Natasza, Rzyman Malgorzata, Danilowicz-Szymanowicz Ludmila, Fijalkowski Marcin
Cardiology Department of Saint Vincent de Paul Hospital in Gdynia, 81-348 Gdynia, Poland.
First Department of Cardiology, Medical University of Gdansk, 80-210 Gdansk, Poland.
J Clin Med. 2022 Feb 21;11(4):1128. doi: 10.3390/jcm11041128.
Thrombus in the left atrial appendage is a contraindication for cardioversion. Sludge is considered similarly as threatening as thrombus; however, the risk of death and ischemic stroke in patients with atrial arrhythmia and thrombus or sludge is not well-known. This study focused on assessing the risk of death and ischemic stroke at one-year follow-up in patients with atrial arrhythmia and thrombus or sludge, as well as the effectiveness of anticoagulation in thrombus resolution. 77 out of 267 (29%) of patients who were scheduled for cardioversion were diagnosed with thrombus or sludge. The annual mortality in patients with thrombus or sludge was 23%. In the group without thrombus, the annual mortality was 1.6%. Overall, 17% of patients with thrombus or sludge experienced ischemic stroke. In patients without thrombus, the risk of stroke was 1%. Sludge increased risk of stroke compared to those without thrombus or sludge by 11% vs. 1%, respectively. No differences in mortality or stroke prevalence were observed between sludge and thrombus. Thrombus or sludge in the LAA have a poor prognosis. A diagnosis of sludge has a similar impact on risk of ischemic strokes as does a diagnosis of thrombus.
左心耳血栓是心脏复律的禁忌症。黏液与血栓一样被视为具有威胁性；然而，房性心律失常合并血栓或黏液的患者的死亡和缺血性卒中风险尚不清楚。本研究的重点是评估房性心律失常合并血栓或黏液的患者在一年随访时的死亡和缺血性卒中风险，以及抗凝治疗在血栓溶解方面的有效性。计划进行心脏复律的267例患者中有77例（29%）被诊断为血栓或黏液。有血栓或黏液的患者的年死亡率为23%。无血栓组的年死亡率为1.6%。总体而言，17%的有血栓或黏液的患者发生了缺血性卒中。无血栓患者的卒中风险为1%。与无血栓或黏液的患者相比，黏液使卒中风险分别增加了11%和1%。在黏液和血栓之间未观察到死亡率或卒中患病率的差异。左心耳血栓或黏液预后较差。黏液诊断对缺血性卒中风险的影响与血栓诊断相似。
