Peverill R E, Harper R W, Gelman J, Gan T E, Harris G, Smolich J J
Cardiology Unit, Monash Medical Centre, Melbourne, Australia.
Circulation. 1996 Aug 1;94(3):331-9. doi: 10.1161/01.cir.94.3.331.
Recent evidence suggests that regional left atrial coagulation activity may be increased in mitral stenosis and perhaps contribute to the pathophysiology of left atrial thrombus. However, the relation of left atrial coagulation activity to factors that predispose to left atrial thrombus formation is unknown, and the relation between left atrial and systemic coagulation activities is unresolved.
Left atrial and peripheral venous levels of the coagulation marker prothrombin fragment 1 + 2 (F1 + 2) were measured in 32 patients with mitral stenosis with normal clotting times and no left atrial thrombus who were undergoing percutaneous balloon mitral valvuloplasty. Baseline peripheral venous F1 + 2 levels, measured at the beginning of the valvuloplasty procedure, did not differ from those of 30 age-matched control patients. Prevalvuloplasty left atrial F1 + 2 levels, obtained immediately after transseptal puncture, were similar to femoral venous levels in patients without left atrial spontaneous echo contrast (LASEC) (0.81 +/- 0.32 versus 0.81 +/- 0.27 nmol/L, n = 7) but greater than femoral venous levels in patients with LASEC and either sinus rhythm (1.57 +/- 0.86 versus 0.99 +/- 0.38 nmol/L, n = 16, P < .001) or atrial fibrillation (1.52 +/- 0.69 versus 0.85 +/- 0.33 nmol/L, n = 9, P < .003). Furthermore, LASEC emerged as the only significant predictor of increased regional left atrial coagulation activity (P = .005) on stepwise multivariate logistic regression analysis.
Increased regional left atrial coagulation activity in mitral stenosis occurs in the presence of LASEC, is evident in either sinus rhythm or atrial fibrillation, and is associated with normal systemic coagulation activity.
近期证据表明，二尖瓣狭窄时左心房局部凝血活性可能增加，这或许有助于左心房血栓的病理生理过程。然而，左心房凝血活性与易导致左心房血栓形成的因素之间的关系尚不清楚，左心房与全身凝血活性之间的关系也未得到解决。
对32例凝血时间正常且无左心房血栓、正在接受经皮球囊二尖瓣成形术的二尖瓣狭窄患者，测定其左心房和外周静脉血中凝血标志物凝血酶原片段1+2（F1+2）的水平。在二尖瓣成形术开始时测定的基线外周静脉F1+2水平，与30例年龄匹配的对照患者无差异。经房间隔穿刺后立即获得的术前左心房F1+2水平，在无左心房自发显影（LASEC）的患者中与股静脉水平相似（0.81±0.32对0.81±0.27nmol/L，n=7），但在有LASEC且为窦性心律（1.57±0.86对0.99±0.38nmol/L，n=16，P<.001）或心房颤动（1.52±0.69对0.85±0.33nmol/L，n=9，P<.003）的患者中高于股静脉水平。此外，在逐步多因素逻辑回归分析中，LASEC成为左心房局部凝血活性增加的唯一显著预测因素（P=.005）。
二尖瓣狭窄时左心房局部凝血活性增加发生于存在LASEC的情况下，在窦性心律或心房颤动中均明显，且与全身正常凝血活性相关。
