Igarashi Y, Yamaura M, Ito M, Inuzuka H, Ojima K, Aizawa Y
Division of Cardiology, Department of Medicine, Tsuruoka City Shonai Hospital, and The First Department of Internal Medicine, Niigata University School of Medicine, Tsuruoka, Yamagata, Japan.
Am Heart J. 1998 Dec;136(6):965-71. doi: 10.1016/s0002-8703(98)70151-6.
Patients with chronic atrial fibrillation have an increased risk of thromboembolism. Apoprotein(a) has a structural homology with plasminogen, suggesting that lipoprotein(a) [Lp(a)] may produce thrombogenic effects by modulating the fibrinolytic system. However, the role of Lp(a) level in the formation of left atrial thrombus has not been studied. We sought to evaluate whether Lp(a) is a risk factor for left atrial thrombus in patients with chronic atrial fibrillation.
The consecutive series of 150 patients (mean age 67 +/- 8 years) with chronic atrial fibrillation underwent transesophageal echocardiography. Left atrial thrombus was diagnosed by transesophageal echocardiography. Clinical, biochemical, and echocardiographic variables were prospectively collected. Univariate analysis showed that patients with left atrial thrombus (n = 29, 19%) had higher frequency of spontaneous echo contrast (93% vs 55%, P <.0001) than patients without left atrial thrombus (n = 121). Patients with left atrial thrombus also had a significantly higher serum concentration of Lp(a) (34.5 +/- 24.1 vs 17.9 +/- 13.5 mg/dL, P <.0001), a larger left atrium (5.4 +/- 0.9 vs 4.8 +/- 0.7 cm, P <.001), and a lower left atrial appendage peak flow velocity (11.1 +/- 5.4 vs 23.5 +/- 14.6 cm/s, P <.0001). Multivariate regression analysis showed that the Lp(a) concentration (P <.0001) was a significant positive predictor and the left atrial appendage peak flow velocity (P =.0125) was a significant negative predictor of left atrial thrombus. Left atrial thrombus was present in 16 (48%) of 33 patients with Lp(a) level >/=30 mg/dL.
Elevated serum levels of Lp(a) are strongly associated with left atrial thrombus. These findings suggest that Lp(a) level may be a novel risk factor for left atrial thrombus in patients with chronic atrial fibrillation.
慢性心房颤动患者发生血栓栓塞的风险增加。载脂蛋白(a)与纤溶酶原具有结构同源性，提示脂蛋白(a)[Lp(a)]可能通过调节纤溶系统产生致血栓作用。然而，Lp(a)水平在左心房血栓形成中的作用尚未得到研究。我们试图评估Lp(a)是否为慢性心房颤动患者左心房血栓形成的危险因素。
连续纳入150例慢性心房颤动患者（平均年龄67±8岁），行食管超声心动图检查。通过食管超声心动图诊断左心房血栓。前瞻性收集临床、生化及超声心动图变量。单因素分析显示，左心房血栓患者（n = 29，19%）的自发显影频率（93%对55%，P <.0001）高于无左心房血栓患者（n = 121）。左心房血栓患者的血清Lp(a)浓度也显著更高（34.5±24.1对17.9±13.5 mg/dL，P <.0001），左心房更大（5.4±0.9对4.8±0.7 cm，P <.001），左心耳峰值流速更低（11.1±5.4对23.5±14.6 cm/s，P <.0001）。多因素回归分析显示，Lp(a)浓度（P <.0001）是左心房血栓的显著正性预测因子，左心耳峰值流速（P =.0125）是左心房血栓的显著负性预测因子。Lp(a)水平≥30 mg/dL的33例患者中有16例（48%）存在左心房血栓。
血清Lp(a)水平升高与左心房血栓密切相关。这些发现提示，Lp(a)水平可能是慢性心房颤动患者左心房血栓形成的一个新的危险因素。
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