孤立性心房颤动患者左房血栓检出率

Incidence of Thrombi within the Left Atrium in Patients of Lone Atrial Fibrillation

目的 观察年龄<60岁、不伴有高血压、糖尿病、心力衰竭、血栓栓塞病史的孤立性心房颤动(简称房颤)患者左房血栓和左房自发显影的检出率。方法 登记2004年1月至2004年11月来本院住院并行食管超声检查的113例房颤患者的病例资料,记录患者的年龄、性别以及高血压、糖尿病、心力衰竭、栓塞史的合并情况。登记患者的左房大小、左室功能情况及经食管超声检查是否存在左房血栓和左房自发显影以及行食管超声检查时是窦性心律还是房颤心律。结果 本组资料中,男77例(68. 1% ),阵发性房颤99例(87. 6% ),患者的平均年龄为53. 3±12. 3岁。年龄在60岁以下的孤立性房颤患者59例(52. 2% ),食管超声左房血栓的检出率为16. 9%,左房血栓或左房自发显影检出率为28. 8%。合并高血压、糖尿病、心力衰竭、脑卒中和周围血管血栓栓塞病史等任何一项危险因素或年龄≥60岁者与年龄<60岁的孤立性房颤患者左房血栓和左房自发显影的检出率均无显著差异(P=0. 827,P=0. 903)。窦性心律和房颤时行食管超声检查左房血栓检出率没有显著差别(P=0. 385)。合并危险因素个数和左房大小与左房血栓检出率有显著相关(P<0. 0001)。结论 即使是孤立性房颤患者,左房血栓和左房自发显影的检出率也非常高,这些患者潜在血栓栓塞的风险不容忽视。

Objective To evaluate the incidence of left atrium thrombus and spontaneous echocardiographic contrast in patients with lone atrial fibrillation. Methods Data of 113 consecutive hospitalized atrial fibrillation patients who underwent transesophageal echocardiography (TEE) since Jan 2004 to Nov 2004 were recorded, including the patients' age, gender, and the presence of thrombosis risk factors arterial hypertension, diabetes mellitus, heart failure, history of ischemic stroke or peripheral thrombosis. Left atrium size, left ventricular ejection fraction (LVEF) and presence of thrombi and spontaneous echocardiographic contrast were recorded. Results Seventy seven(68.1%)were male in this group of patients.The mean age was 53.3±12.3 years old, 99(87.6%)of the patients had paroxysmal atrial fibrillation. There were 59(52.2%)patients younger than 60 years old with lone atrial fibrillation, who had an incidence of 16.9% for left atrium thrombus and 28.8% for left atrium thrombus/ spontaneous echocardiographic contrast in TEE, that was not significantly different from patients presented with one or more risk factors( P =0.827, P =0.903).The incidence of left atrium thrombus was irrespective of sinus rhythm or atrial fibrillation when the TEE was performed. Left atrium size and number of risk factors were significantly related to the incidence of left atrium thrombi( P <0.0001). Conclusions Even if in patients of lone atrial fibrillation without any risk factor of thrombosis, the incidence of left atrium thrombus and spontaneous echocardiographic contrast were quite high and the risk of thrombosis should not be neglected.