不同病因心房颤动患者卒中危险的评估

Evaluation of stroke risks in patients w ith atrial fibrillation due to different pathogenesis

目的本研究旨在比较不同病因的房颤患者左心耳血栓前状态、血栓形成以及临床缺血性脑卒中发生率的异同。方法持续性房颤患者140例,按是否存在动脉粥样硬化相关疾病,分为伴有动脉粥样硬化相关疾病组(AS组)和非动脉粥样硬化相关疾病组(NAS组),应用经胸超声和经食管超声(TEE)技术,比较两组患者心脏结构和功能改变,检测患者左心耳血流速度,观察是否存在重度自发声学显影(SEC)、血栓以及临床是否存在缺血性脑卒中。结果与NAS组比较,AS组患者左心耳重度SEC(71.6%vs 47.0%)、左心耳血栓(35.1%vs16.7%)和缺血性脑卒中(19.8%vs 9.9%)的发生率显著增加(P<0.05);两组间左室收缩功能、左房内径和面积、左心耳面积和血流速度均差异无统计学意义(P>0.05)。结论伴有动脉粥样硬化相关疾病的房颤患者左心耳血栓前状态、血栓形成以及临床缺血性脑卒中的发生率显著高于非动脉粥样硬化相关疾病的房颤患者,提示对此类患者的处理需要独特的策略,为房颤患者抗凝治疗的个体化研究提供了依据。

Objective To compare the incidences of left atrial appendage （LAA） prothrombotic state, LAA thrombus and ischemic stroke of persistent atrial fibrillation （AF） patients with different pathogenesis. Methods One hundred and forty patients with persistent AF were divided into atherosclerosis related group （AS group） and non-atherosclerosis related group （NAS group）. Transthoracic echocardiography （TTE） and transesophageal （TEE） echocardiography evaluation were performed to measure cardiac structure, cardiac function, LAA flow velocity, LAA spontaneous echo contrast （SEC） and LAA thrombus. The medical history of stroke was recorded. Results Compared with the NAS group, the incidences of LAA SEC （71.6% vs 47.0%）, LAA thrombus （35.1% vs 16.7%） and ischemic stroke （19.8% vs 9.9%） of the AS group significantly increased （P〈0.05）. There were no differences in left ventricular systolic function, left atrial （LA） internal diameter, LA area, LAA area, and LAA flow velocity between the two groups （P〉0.05）. Conclusion The incidences of LAA prothrombotic state, LAA thrombus and ischemic stroke of AF patients with AS-related diseases were higher compared with patients without AS-related diseases, indicating that the management of the AF patients with AS-related diseases need special strategies. Our study contributed to the individualized-treatment evidence of the anticoagulation therapy of AF patients.