Cui Jing, Xia Shi-Jun, Tang Ri-Bo, He Liu, Guo Xue-Yuan, Li Song-Nan, Liu Nian, Sang Cai-Hua, Long De-Yong, Du Xin, Dong Jian-Zeng, Ma Chang-Sheng
Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Chaoyang District, Beijing, Zip, 100029, PR China.
BMC Cardiovasc Disord. 2024 Jul 31;24(1):398. doi: 10.1186/s12872-024-04073-w.
Stroke and thromboembolism in nonvalvular atrial fibrillation (NVAF) primarily arise from thrombi or sludge in the left atrial appendage (LAA). Comprehensive insight into the characteristics of these formations is essential for effective risk assessment and management.
We conducted a single-center retrospective observational of 176 consecutive NVAF patients with confirmed atrial/appendage thrombus or sludge determined by a pre-ablation transesophageal echocardiogram (TEE) from December 2017 to April 2019. We obtained clinical and echocardiographic characteristics, including left atrial appendage emptying velocity (LAAeV) and filling velocity (LAAfV). Data analysis focused on identifying the morphology and location of thrombus or sludge. Patients were divided into the solid thrombus and sludge groups, and the correlation between clinical and echocardiographic variables and thrombotic status was analyzed.
Morphological classification: In total, thrombi were identified in 78 patients, including 71 (40.3%) mass and 7 (4.0%) lamellar, while sludge was noted in 98 (55.7%). Location classification: 92.3% (72/78) of patients had thrombus confined to the LAA; 3.8% (3/78) had both LA and LAA involvement; 2.7% (2/78) had LA, LAA and RAA extended into the RA, the remained 1.2%(1/78) was isolated to RAA. 98.0% (96/98) of patients had sludge confined to the LAA; the remaining 2.0% (2/98) were present in the atrial septal aneurysm, which protrusion of interatrial septum into the RA. The thrombus and sludge groups showed low LAAeV (19.43 ± 9.59 cm/s) or LAAfV (17.40 ± 10.09 cm/s). Only LA dimension ≥ 40 mm was independently associated with the thrombus state in the multivariable model.
This cohort study identified rare thrombus morphology and systematically summarized the classification of thrombus morphology. The distribution of thrombus and sludge outside limited to LAA was updated, including bilateral atrial and appendage involvement and rare atrial septal aneurysm sludge. LAAeV and LAAfV were of limited value in distinguishing solid thrombus from sludge.
ChiCTR-OCH-13,003,729.
非瓣膜性心房颤动（NVAF）中的中风和血栓栓塞主要源于左心耳（LAA）中的血栓或淤滞。全面了解这些结构的特征对于有效的风险评估和管理至关重要。
我们对2017年12月至2019年4月期间176例经消融前经食管超声心动图（TEE）确诊为心房/心耳血栓或淤滞的连续NVAF患者进行了单中心回顾性观察。我们获取了临床和超声心动图特征，包括左心耳排空速度（LAAeV）和充盈速度（LAAfV）。数据分析重点在于确定血栓或淤滞的形态和位置。患者分为固体血栓组和淤滞组，并分析临床和超声心动图变量与血栓形成状态之间的相关性。
形态学分类：总共在78例患者中发现血栓，其中71例（40.3%）为团块状，7例（4.0%）为片状，而98例（55.7%）发现有淤滞。位置分类：92.3%（72/78）的患者血栓局限于LAA；3.8%（3/78）的患者左心房（LA）和LAA均受累；2.7%（2/78）的患者LA、LAA和右心耳（RAA）延伸至右心房（RA），其余1.2%（1/78）仅累及RAA。98.0%（96/98）的患者淤滞局限于LAA；其余2.0%（2/98）存在于房间隔瘤中，即房间隔向RA突出处。血栓组和淤滞组的LAAeV（19.43±9.59 cm/s）或LAAfV（17.40±10.09 cm/s）均较低。在多变量模型中只有LA直径≥40 mm与血栓状态独立相关。
这项队列研究确定了罕见的血栓形态，并系统总结了血栓形态分类。更新了血栓和淤滞在LAA以外的分布情况，包括双侧心房和心耳受累以及罕见的房间隔瘤淤滞。LAAeV和LAAfV在区分固体血栓和淤滞方面价值有限。
ChiCTR - OCH - 13003729。
