Minami Kentaro, Machino-Ohtsuka Tomoko, Nakatsukasa Tomofumi, Kawamatsu Naoto, Sato Kimi, Yamamoto Masayoshi, Yamasaki Hiro, Kawakami Yasushi, Ishizu Tomoko
Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba.
Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba; Department of Clinical Laboratory Medicine, Institute of Medicine, University of Tsukuba, Tsukuba.
Int J Cardiol. 2025 Jan 15;419:132682. doi: 10.1016/j.ijcard.2024.132682. Epub 2024 Oct 23.
The clinical significance of echocardiographic left ventricular hypertrophy (LVH) in risk stratification of left atrial appendage (LAA) thrombogenic milieu, as a surrogate for cardioembolic risk, in patients with atrial fibrillation (AF) and HADS-VASc scores of 0-2 is unknown.
We enrolled 707 consecutive patients with AF and CHADS-VASc scores of 0-2 who underwent transesophageal echocardiography. LAA thrombogenic milieu was defined as the presence of a thrombus, severe spontaneous echo contrast, sludge in the LAA, or LAA flow velocity ≤ 20 cm/s. Alongside conventional parameters, longitudinal strain values for the left ventricle (LV) and left atrium were obtained using transthoracic echocardiography. Among the 707 patients, 77 (10.9 %) exhibited LVH. The LVH group exhibited a significantly higher prevalence of LAA thrombogenic milieu than the non-LVH group (32.5 % vs. 2.5 %, p < 0.001). LVH independently associated with LAA thrombogenic milieu after adjusting for clinical factors (including CHADS-VASc score, AF type, and serum brain natriuretic peptide levels) and conventional echocardiographic parameters (including LV ejection fraction, LV end-diastolic volume index, and left atrium volume index) (odds ratio [OR]: 7.54, 95 % confidence interval [CI]: 3.49-16.29, p < 0.001 and OR: 7.16, 95 % CI: 3.26-15.73, p < 0.001, respectively). Moreover, LVH provided incremental value for predicting LAA thrombogenic milieu, even when added to the longitudinal strain of the LV and left atrium reservoir strains (p < 0.001).
Echocardiographic LVH significantly improves the prediction of LAA thrombogenic milieu, offering potential utility in further cardioembolic risk stratification for patients with AF and CHADS-VASc scores of 0-2.
在心房颤动（AF）且HADS-VASc评分为0-2的患者中，超声心动图左心室肥厚（LVH）作为心脏栓塞风险的替代指标，在左心耳（LAA）血栓形成环境风险分层中的临床意义尚不清楚。
我们连续纳入了707例AF且CHADS-VASc评分为0-2并接受经食管超声心动图检查的患者。LAA血栓形成环境定义为存在血栓、严重自发回声增强、LAA内有淤滞或LAA流速≤20 cm/s。除了传统参数外，还使用经胸超声心动图获得左心室（LV）和左心房的纵向应变值。在这707例患者中，77例（10.9%）表现出LVH。LVH组LAA血栓形成环境的患病率显著高于非LVH组（32.5%对2.5%，p<0.001）。在调整临床因素（包括CHADS-VASc评分、AF类型和血清脑钠肽水平）和传统超声心动图参数（包括LV射血分数、LV舒张末期容积指数和左心房容积指数）后，LVH与LAA血栓形成环境独立相关（优势比[OR]：7.54，95%置信区间[CI]：3.49-16.29，p<0.001；OR：7.16，95%CI：3.26-15.73，p<0.001）。此外，即使将LVH添加到LV和左心房储备应变的纵向应变中，它在预测LAA血栓形成环境方面也具有增量价值（p<0.001）。
超声心动图LVH显著改善了对LAA血栓形成环境的预测，在AF且CHADS-VASc评分为0-2的患者进一步心脏栓塞风险分层中具有潜在应用价值。
