Li Y H, Hwang J J, Tseng Y Z, Kuan P, Lien W P
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Republic of China.
Chest. 1995 Aug;108(2):359-63. doi: 10.1378/chest.108.2.359.
Seventy-eight patients with chronic nonrheumatic atrial fibrillation were studied by transesophageal echocardiography with regard to the left atrial appendage function and its relation to the coarseness of atrial fibrillation on electrocardiogram. These 78 patients (52 men and 26 women; mean age, 66 +/- 10 years; range, 40 to 94 years) were classified into two groups according to the presence of coarse (group 1, n = 46; those with the greatest amplitude of fibrillatory wave in lead V1 > or = 1 mm) or fine (group 2, n = 32; those without the coarse fibrillatory wave in lead V1) atrial fibrillation on a standard 12-lead electrocardiogram within 1 month of echocardiographic studies. There were no significant differences in age, sex, mean duration of atrial fibrillation, left ventricular end-diastolic dimension, left ventricular end-systolic dimension, left ventricular ejection fraction, and left atrial dimension between the two groups. In group 1, however, the left atrial appendage ejection fraction (24.4 +/- 14.2% vs 32.6 +/- 14.8%; p < 0.05) and the peak emptying velocity (21.7 +/- 12.6 cm/s vs 30.4 +/- 14.3 cm/s; p < 0.01) were lower than those in group 2. There were higher incidences of left atrial appendage spontaneous echo contrast (26/46 vs 7/32; p < 0.005) and thrombus (8/46 vs 0/32; p < 0.05) in group 1 patients. The coarse atrial fibrillation revealed a sensitivity of 80.0%, a specificity of 58.1%, a positive predictive value of 60.9%, and a negative predictive value of 78.1% for the presence of left atrial appendage spontaneous echo contrast and/or thrombus formation. In conclusion, in patients with coarse nonrheumatic atrial fibrillation, the left atrial appendage function is usually poor and the incidence of spontaneous echo contrast and thrombus formation appears to be higher in these patients.
采用经食管超声心动图对78例慢性非风湿性心房颤动患者的左心耳功能及其与心电图上房颤粗钝程度的关系进行了研究。这78例患者（52例男性，26例女性；平均年龄66±10岁；范围40至94岁）根据在超声心动图检查后1个月内标准12导联心电图上是否存在粗钝型房颤（第1组，n = 46；V1导联中颤动波最大振幅≥1 mm）或纤细型房颤（第2组，n = 32；V1导联中无粗钝颤动波）分为两组。两组在年龄、性别、房颤平均持续时间、左心室舒张末期内径、左心室收缩末期内径、左心室射血分数和左心房内径方面无显著差异。然而，在第1组中，左心耳射血分数（24.4±14.2% 对 32.6±14.8%；p < 0.05）和峰值排空速度（21.7±12.6 cm/s 对 30.4±14.3 cm/s；p < 0.01）低于第2组。第1组患者左心耳自发显影（26/46对7/32；p < 0.005）和血栓（8/46对0/32；p < 0.05）的发生率更高。粗钝型房颤对于左心耳自发显影和/或血栓形成的存在，显示出80.0%的敏感性、58.1%的特异性、60.9%的阳性预测值和78.1%的阴性预测值。总之，在粗钝型非风湿性房颤患者中，左心耳功能通常较差，这些患者中自发显影和血栓形成的发生率似乎更高。
