自发显影的存在并未增加左心耳封堵的风险：基于CLACBAC研究的倾向评分匹配分析。
The presence of spontaneous echo contrast didn't increase the risk for left atrial appendage closure: A propensity score matching analysis based on the CLACBAC study.
作者信息
Zhang Jun, Zhou Lili, Ren Zhongyuan, Feng Shiyu, Wu Jiayu, Yang Haotian, Zheng Yixing, Meng Weilun, Su Yang, Xu Jun, Sun Hui, Zhao Yifan, Xie Yun, Xu Yawei, Zhao Dongdong
机构信息
Heart Center, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
Tongji University School of Medicine, Shanghai, China.
出版信息
Heliyon. 2024 Aug 22;10(17):e36647. doi: 10.1016/j.heliyon.2024.e36647. eCollection 2024 Sep 15.
BACKGROUND
Left atrial appendage closure (LAAC) was effective in preventing thromboembolic events and stroke in patients with atrial fibrillation (AF). However, whether left atrial spontaneous echo contrast (LA-SEC) poses a higher risk for thromboembolism is contradictory. We aimed to investigate whether LA-SEC is a risk factor for thromboembolic events in patients who underwent LAAC.
METHODS
258 consecutive patients who underwent successful LAAC were enrolled and divided according to the presence or absence of LA-SEC detected by transesophageal echocardiography (TEE). Propensity score matching (PSM) was used to eliminate covariate imbalances. Baseline characteristics, periprocedural details, and clinical outcomes were compared between LA-SEC and non-LA-SEC groups and PSM-matched groups.
RESULTS
Of the 258 patients enrolled, mean age was 71.8 ± 8.3 years and 59.3 % were male. LA-SEC group had a higher percentage of persistent AF and worse cardiac function. No significant difference in peri-procedure parameters was found. Through follow-up of 38.1 ± 10.7 months, the total incidence of thromboembolic events and stroke was 7.8 % and 6.6 %, respectively. Though the event-free survival rate of thromboembolic events (Log-Rank P = 0.042) and stroke (Log-Rank P = 0.010) was significantly lower in the LA-SEC group, multivariable COX regression analysis showed LA-SEC was not an independent predictor of thromboembolic events (Hazard ratio 2.073, 95 % Confidence interval 0.845-5.082, P = 0.111). Further survival analysis between PSM-matched groups with comparable baseline characteristics presented no significant difference in survival free from thromboembolic events (Log-Rank P = 0.616) and stroke (Log-Rank P = 0.312).
CONCLUSION
Patients with LA-SEC had worse condition, while LA-SEC per se did not increase the incidence of thromboembolic events and stroke for patients who underwent LAAC.
背景
左心耳封堵术（LAAC）在预防心房颤动（AF）患者的血栓栓塞事件和中风方面是有效的。然而，左心房自发显影（LA-SEC）是否会带来更高的血栓栓塞风险存在争议。我们旨在研究LA-SEC是否是接受LAAC患者发生血栓栓塞事件的危险因素。
方法
连续纳入258例成功接受LAAC的患者，并根据经食管超声心动图（TEE）检测到的LA-SEC的有无进行分组。采用倾向评分匹配（PSM）来消除协变量不平衡。比较LA-SEC组和非LA-SEC组以及PSM匹配组之间的基线特征、围手术期细节和临床结局。
结果
在纳入的258例患者中，平均年龄为71.8±8.3岁，男性占59.3%。LA-SEC组持续性AF的比例更高，心功能更差。围手术期参数未发现显著差异。经过38.1±10.7个月的随访，血栓栓塞事件和中风的总发生率分别为7.8%和6.6%。虽然LA-SEC组血栓栓塞事件（Log-Rank P = 0.042）和中风（Log-Rank P = 0.010）的无事件生存率显著较低，但多变量COX回归分析显示LA-SEC不是血栓栓塞事件的独立预测因素（风险比2.073，95%置信区间0.845 - 5.082，P = 0.111）。对具有可比基线特征的PSM匹配组进行的进一步生存分析显示，无血栓栓塞事件生存（Log-Rank P = 0.616）和中风生存（Log-Rank P = 0.312）无显著差异。
结论
LA-SEC患者病情较差，而LA-SEC本身并未增加接受LAAC患者的血栓栓塞事件和中风发生率。
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