Leung D Y, Black I W, Cranney G B, Hopkins A P, Walsh W F
Department of Cardiovascular Medicine, Prince Henry Hospital, Sydney, New South Wales, Australia.
J Am Coll Cardiol. 1994 Sep;24(3):755-62. doi: 10.1016/0735-1097(94)90025-6.
This study examined the influence of left atrial spontaneous echo contrast on the subsequent stroke or embolic event rate and on survival in patients with nonvalvular atrial fibrillation.
Left atrial spontaneous echo contrast is associated with atrial fibrillation and a history of previous stroke or other embolic events. However, the prognostic implications of spontaneous contrast in patients with nonvalvular atrial fibrillation are unknown.
The study group comprised 272 consecutive patients with nonvalvular atrial fibrillation undergoing transesophageal echocardiography. Clinical and echocardiographic data were collected at baseline, and patients were prospectively followed up, and all strokes, other embolic events and deaths were documented. The relation between spontaneous contrast at baseline and subsequent stroke, other embolic events and survival was analyzed.
Left atrial spontaneous echo contrast was detected at baseline in 161 patients (59%). The mean follow-up was 17.5 months. The stroke or other embolic event rate was 12%/year (15 strokes, 3 transient ischemic attacks, 2 peripheral embolisms) in patients with, compared with 3%/year (5 strokes) in patients without, baseline spontaneous contrast (p = 0.002). In 149 patients without previous thromboembolism, the event rate was 9.5%/year in patients with and 2.2%/year in patients without spontaneous contrast (p = 0.003). There were 25 deaths in patients with and 11 deaths in patients without spontaneous contrast. Patients with spontaneous contrast had significantly reduced survival (p = 0.025). On multivariate analysis, spontaneous contrast was the only positive predictor (odds ratio 3.5, p = 0.03) and warfarin therapy on follow-up the only negative predictor (odds ratio 0.23, p = 0.02) of subsequent stroke or other embolic events.
Transesophageal echocardiography can risk stratify patients with nonvalvular atrial fibrillation by identifying left atrial spontaneous echo contrast. These patients have both a significantly higher risk of developing stroke or other embolic events and a reduced survival, and they may represent a subgroup in whom the risk/benefit ratio of anticoagulation may be most favorable.
本研究探讨了左心房自发显影对比对非瓣膜性心房颤动患者后续中风或栓塞事件发生率及生存率的影响。
左心房自发显影对比与心房颤动以及既往中风或其他栓塞事件史相关。然而，非瓣膜性心房颤动患者中自发对比的预后意义尚不清楚。
研究组包括272例连续接受经食管超声心动图检查的非瓣膜性心房颤动患者。在基线时收集临床和超声心动图数据，并对患者进行前瞻性随访，记录所有中风、其他栓塞事件和死亡情况。分析基线时自发对比与后续中风、其他栓塞事件及生存率之间的关系。
161例患者（59%）在基线时检测到左心房自发显影对比。平均随访时间为17.5个月。有基线自发对比的患者中风或其他栓塞事件发生率为每年12%（15例中风、3例短暂性脑缺血发作、2例周围性栓塞），而无基线自发对比的患者为每年3%（5例中风）（p = 0.002）。在149例既往无血栓栓塞的患者中，有自发对比的患者事件发生率为每年9.5%，无自发对比的患者为每年2.2%（p = 0.003）。有自发对比的患者中有25例死亡，无自发对比的患者中有11例死亡。有自发对比的患者生存率显著降低（p = 0.025）。多因素分析显示，自发对比是后续中风或其他栓塞事件的唯一阳性预测因素（比值比3.5，p = 0.03），随访期间的华法林治疗是唯一的阴性预测因素（比值比0.23，p = 0.02）。
经食管超声心动图可通过识别左心房自发显影对比对非瓣膜性心房颤动患者进行危险分层。这些患者发生中风或其他栓塞事件的风险显著更高，且生存率降低，他们可能代表抗凝治疗风险/获益比可能最有利的一个亚组。
