Cardiovascular Research Institute, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China ; and.
Ultrasound Department, Anshan City Central Hospital, Anshan, Liaoning Province, China .
J Cardiovasc Pharmacol. 2024 Jul 1;84(1):118-123. doi: 10.1097/FJC.0000000000001567.
This study seeks to identify the anticoagulant efficacy of rivaroxaban treatment on thrombi detected using echocardiography of the left atrial appendage in 275 patients with persistent atrial fibrillation. During follow-up after 9-24 weeks of rivaroxaban treatment, patients were divided into "effective group" (n = 143) and "ineffective group" (n = 132) according to the thrombolytic effect of the drug. Left atrial diameter (LAD), left atrial ejection fraction (LAEF), left ventricular ejection fraction (LVEF), mean diameter of left atrial appendage (LAAD mean ), angle between left atrial appendage and left atrium (LAA-A), velocity of blood flow in left atrial appendage (LAA-v), and thrombus size were compared before and after drug administration. Following treatment, LAEF, LVEF, and LAA-v values were greater and LAD and LAAD mean values were lower in the effective ( P < 0.05). Logistic regression analysis showed significant correlations of LAD, LAEF, LVEF, LAA-A, and LAA-v with anticoagulant efficacy ( P < 0.05). The efficacy of rivaroxaban in treatment of left atrial auricular thrombosis in patients with persistent AF was correlated with LAD, LAEF, LVEF, LAA-A, and LAA-v. Multivariate logistic regression analysis further revealed LAEF [odds ratio (OR) 1.7, 95% confidence interval (CI), 0.45-16.9, P = 0.008], 3D-EF (OR 6.4, 95% CI, 1.06-16.9, P = 0.039) and left ventricular global longitudinal strain (OR 18.0, 95% CI, 1.38-35.68, P = 0.028) as factors related to left atrial appendage thrombus. Echocardiography with global longitudinal strain assessment could be effectively utilized to evaluate the functional parameters of LAA and thus aid in predicting the safety of rivaroxaban as an anticoagulation agent.
本研究旨在通过经胸超声心动图左心耳（LAA）检查，确定利伐沙班治疗持续性心房颤动（AF）患者血栓的抗凝疗效。在利伐沙班治疗 9-24 周的随访中，根据药物溶栓效果将 275 例患者分为“有效组”（n = 143）和“无效组”（n = 132）。比较用药前后左心房直径（LAD）、左心房射血分数（LAEF）、左心室射血分数（LVEF）、左心耳平均直径（LAADmean）、左心耳与左心房夹角（LAA-A）、左心耳血流速度（LAA-v）及血栓大小。治疗后有效组 LAEF、LVEF 和 LAA-v 值升高，LAD 和 LAADmean 值降低（P < 0.05）。Logistic 回归分析显示，LAD、LAEF、LVEF、LAA-A 和 LAA-v 与抗凝疗效显著相关（P < 0.05）。利伐沙班治疗持续性 AF 患者左心耳血栓的疗效与 LAD、LAEF、LVEF、LAA-A 和 LAA-v 相关。多因素 Logistic 回归分析进一步显示 LAEF[比值比（OR）1.7，95%置信区间（CI）0.45-16.9，P = 0.008]、3D-EF（OR 6.4，95%CI，1.06-16.9，P = 0.039）和左心室整体纵向应变（OR 18.0，95%CI，1.38-35.68，P = 0.028）是左心耳血栓相关的因素。超声心动图整体纵向应变评估可有效用于评估 LAA 的功能参数，从而有助于预测利伐沙班作为抗凝药物的安全性。
