应用CHADS2评分预测非瓣膜性心房颤动患者左心房/左心耳血栓

Application of CHADS2 score in prediction of left atrial/left atrial appendage thrombus in patients with nonvalvular atrial fibrillation

目的探讨非瓣膜性心房颤动(简称房颤)患者CHADS2评分与其左心房/左心耳(LA/LAA)血栓患病率间的关系。方法回顾性分析187例非瓣膜性房颤患者资料,对其进行CHADS2评分,根据TEE检查结果分为血栓组及非血栓组,分析CHADS2评分与LA/LAA血栓患病率间的关系及各因子在两组中的差异。结果 187例中,27例(27/187,14.44%)确诊为LA/LAA血栓,其中0分者1例(1/47,2.13%),1分者11例(11/82,13.41%),2分者8例(8/33,24.24%),3分者5例(5/17,29.41%),4分者1例(1/6,16.67%),5分者1例(1/2,50.00%);随着CHADS2评分增高,非瓣膜性房颤患者LA/LAA血栓的患病率呈增高趋势(P=0.001)。血栓组中伴有充血性心力衰竭者占37.04%(10/27),高于非血栓组(χ2=5.92,P=0.02);而CHADS2评分标准中的其他因子在两组中的差异均无统计学意义(P均>0.05)。结论随着CHADS2评分增高,非瓣膜性房颤患者LA/LAA血栓的患病率呈增高趋势;充血性心力衰竭是LA/LAA血栓的独立危险因素。

Objective： To explore the correlation between CHADS2 score and prevalence of left atrial/left atrial appendage （LA/LAA） thrombus in patients with nonvalvular atrial fibrillation （NVAF）. Methods： Clinical data of 187 NVAF patients were analyzed, and CHADS2 score were derived. The patients were divided into thrombus group and non-thrombus group based on the results of TEE. The association between CHADS2 score and prevalence of LA/LAA thrombus, and frequency differences of CHADS2 factors between thrombus group and non-thrombus groups were analyzed. Results： The prevalence of LA/LAA thrombus was 14.44% （27/187）, and the detection rate of thrombus was 2.13% （1/47）, 13.41% （11/82）, 24.24% （8/33）, 29.41% （5/17）, 16.67% （1/6）, 50.00% （1/2） in patients with CHADS2 score of 0, 1, 2, 3, 4 and 5, respectively. The prevalence of LA/LAA thrombus showed a trend of increase with the raising of CHADS2 score, and both of them had significant correlation （P=0.001）. In thrombus group, 37.04% （10/27） patients had history of congestive heart failure, higher than those in non-thrombus group （χ2=5.92, P=0.02）. Of other factors of CHADS2 score, there was no significant difference between thrombus group and non-thrombus groups （all P〉0.05）. Conclusion： In NVAF patients, the prevalence of LA/LAA thrombus increases significantly with higher CHADS2 scores. Congestive heart failure is the only independent associated risk factor of LA/LAA thrombus.