Xu Wei, Yang Yanmin, Zhu Jun, Tan Jiangshan, Wang Jingyang, Wang Lulu
Emergency Center, State Key Laboratory of Cardiovascular Disease of China, National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
J Cardiovasc Dev Dis. 2022 Nov 30;9(12):426. doi: 10.3390/jcdd9120426.
Aims: Patients with left ventricular noncompaction (LVNC) are at risk of thromboembolism. The relationship between left atrial diameter (LAD), a robust predictor for thrombosis, and LVNC is unclear. The purpose of this study was to explore the effect of LAD on the thrombotic risk in LVNC. Methods: In this retrospective cohort study, 320 patients with imaging characteristics of LVNC were included for statistical analysis. The primary endpoint was a composite event of intracardiac thrombi and stroke or transient ischemic attack (TIA). The secondary endpoints were intracardiac thrombi and stroke/TIA. Results: The 320 included patients (211 [65.9%] men, median age: 45 years [interquartile range: 30−57]) were divided into LAD1 (<43 mm, n = 157) and LAD2 (≥43 mm, n = 163) groups based on the median LAD. Throughout the median follow-up of 34 months, the incidence of thromboembolism among them was 7.2%: 11 (3.4%) patients had stroke/TIA and 14 (4.4%) had intracardiac thrombi. The rate of thromboembolism in the LAD2 group was higher than that of patients in the LAD1 group (11.0% vs. 3.2%, p = 0.007). Kaplan−Meier survival curves suggested that a LAD ≥ 43 mm was associated with a higher risk of thromboembolism and intracardiac thrombi (log-rank test, all p < 0.05). After adjusting for potential risk factors, LAD ≥ 43 mm was found to be an independent risk factor for thromboembolism (p = 0.013) and stroke (p = 0.024). The area under the receiver operating characteristic curve of LAD for predicting thromboembolism reached 0.696 at 1 year, 0.635 at 2 years, and 0.660 at 3 years. Conclusions: A larger LAD was related to a higher risk of thromboembolism in patients with LVNC. The LAD may be a useful predictor for thrombotic risk stratification among such patients.
左心室心肌致密化不全（LVNC）患者存在血栓栓塞风险。左心房直径（LAD）作为血栓形成的有力预测指标，与LVNC之间的关系尚不清楚。本研究旨在探讨LAD对LVNC患者血栓形成风险的影响。方法：在这项回顾性队列研究中，纳入320例具有LVNC影像学特征的患者进行统计分析。主要终点是心内血栓形成以及中风或短暂性脑缺血发作（TIA）的复合事件。次要终点是心内血栓形成以及中风/TIA。结果：纳入的320例患者（211例[65.9%]为男性，中位年龄：45岁[四分位间距：30 - 57岁]）根据LAD中位数分为LAD1组（<43 mm，n = 157）和LAD2组（≥43 mm，n = 163）。在34个月的中位随访期内，他们的血栓栓塞发生率为7.2%：11例（3.4%）患者发生中风/TIA，14例（4.4%）患者有心内血栓形成。LAD2组的血栓栓塞发生率高于LAD1组（11.0%对3.2%，p = 0.007）。Kaplan - Meier生存曲线表明，LAD≥43 mm与更高的血栓栓塞和心内血栓形成风险相关（对数秩检验，所有p < 0.05）。在对潜在危险因素进行校正后，发现LAD≥43 mm是血栓栓塞（p = 0.013）和中风（p = 0.024）的独立危险因素。LAD预测血栓栓塞的受试者工作特征曲线下面积在1年时达到0.696，2年时为0.635，3年时为0.660。结论：更大的LAD与LVNC患者更高的血栓栓塞风险相关。LAD可能是此类患者血栓形成风险分层的有用预测指标。
