Yang Shu, Yang Jie, Chen Ning, Cui Chang, Jiao Jincheng, Zhu Li, Li Mingfang, Chen Minglong
Division of Cardiology, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, Jiangsu, China.
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
Clin Appl Thromb Hemost. 2025 Jan-Dec;31:10760296251324922. doi: 10.1177/10760296251324922. Epub 2025 Mar 18.
BackgroundTo investigate the relationship between heart failure (HF) and the non-resolution of atrial thrombus detected in anticoagulated patients with non-valvular atrial fibrillation (NVAF).MethodsThis was a single-center, observational, retrospective, and prospective study. Anticoagulated patients with NVAF and atrial thrombus identified by transesophageal echocardiography or cardiac computed tomography angiography were consecutively enrolled. All patients received follow-up imaging within 6 months to assess the resolution of atrial thrombus. The primary endpoint was the resolution of atrial thrombus and the secondary endpoint was the occurrence of ischemic stroke, major bleeding, and all-cause death during the follow-up period.ResultsAmong 8987 patients with NVAF scheduled for catheter ablation or cardioversion, 70 anticoagulated patients with atrial thrombus were final analyzed. The average age was 61.8±10.6 years, 62.9% of them were men, and 32 (45.7%) patients presented with HF. Within the 6-month follow-up period, atrial thrombus resolution was observed in 47 (67.1%) patients. The rate of atrial thrombus resolution was lower in patients with baseline HF (50.0% vs 81.6%). In the adjusted logistic regression analysis model, HF was independently associated with the non-resolution of atrial thrombus (adjusted OR: 5.38, 95% CI: 1.19-24.27). During the median follow-up period of 4.5 years, four ischemic stroke events occurred in four patients. None of the patients in this study experienced major bleeding events or death during follow-up.ConclusionsHF was associated with the non-resolution of atrial thrombus detected in anticoagulated patients with NVAF. Further research is needed to identify optimal therapeutic approaches for this high-risk population.
背景
探讨心力衰竭（HF）与非瓣膜性心房颤动（NVAF）抗凝患者心房血栓未溶解之间的关系。
方法
这是一项单中心、观察性、回顾性和前瞻性研究。连续纳入经食管超声心动图或心脏计算机断层扫描血管造影确诊为NVAF且伴有心房血栓的抗凝患者。所有患者在6个月内接受随访成像，以评估心房血栓的溶解情况。主要终点是心房血栓的溶解，次要终点是随访期间缺血性卒中、大出血和全因死亡的发生情况。
结果
在计划进行导管消融或心脏复律的8987例NVAF患者中，最终分析了70例伴有心房血栓的抗凝患者。平均年龄为61.8±10.6岁，其中62.9%为男性，32例（45.7%）患者患有HF。在6个月的随访期内，47例（67.1%）患者的心房血栓溶解。基线时患有HF的患者心房血栓溶解率较低（50.0%对81.6%）。在调整后的逻辑回归分析模型中，HF与心房血栓未溶解独立相关（调整后的OR：5.38，95%CI：1.19-24.27）。在中位随访期4.5年期间，4例患者发生了4次缺血性卒中事件。本研究中没有患者在随访期间发生大出血事件或死亡。
结论
HF与NVAF抗凝患者中检测到的心房血栓未溶解有关。需要进一步研究以确定针对这一高危人群的最佳治疗方法。
