非瓣膜性心房颤动患者左心房血栓和／或自发显影危险因素分析

Risk factors of left atrial thrombus or spontaneous echo contrast in patients with non-valvular atrial fibrillation

目的探索非瓣膜性心房颤动（房颤）患者左心房血栓（LAT）和／或自发显影（SEC）的危险因素。方法选择2007年7月至2012年12月在广东省人民医院住院的1544例非瓣膜性房颤患者，平均年龄（57．1±11．9）岁，男1046例，女498例，阵发性房颤1297例。根据食管超声心动图（TEE）结果分为两组：LAT和／或SEC组（109例）和无LAT和／或SEC组（1435例）。记录患者年龄、性别、房颤类型、发生房颤时间、合并疾病、超声心动图指标等，进行多因素Logistic回归分析确定LAT和／或SEC形成的独立危险因素。结果LAT和／或SEC组：LAT53例（3．4％），血栓均位于左心耳；SEC56例（3．6％）。Logistic回归分析显示持续性及长期持续性房颤（OR=1．7，95％CI1．1—2．4）、女性（OR=1．7，95％CI1．1—2．7）、心肌病（OR=2．8，95％CI1．3—5．7）、左心室射血分数（LVEF）≤0．40（OR：6．0，95％CI2．0～18．2）、左心房内径（LAD）≥40mm（OR=7．1，95％CI4．4～11．4）为TJAT或SEC形成的独立危险因素（P〈0．05）．结论LAD≥40mm、LVEF≤0．40是LAT或SEC形成的最强独立预测因素，对预测房颤栓塞事件可能具有重要价值。

Objective To examine the incidence and risk factors of left atrial thrombus（LAT） and/or spontaneous echo-contrast（SEC） in patients with non-valvular atrial fibrillation（AF）. Methods The study included 1544 consecutive inpatients [ mean age （ 57.1± 11.9 ） years, 32% female, 1297 paroxysmal AF （ 84% ） with non-valvular AF who underwent transesophageal echocardiography （TEE） between July 2007 and Decem- ber 2012.According to TEE results, patients were divided into two groups ：LAT/SEC group （n = 109） and non- LAT/SEC group （n= 1435 ）.Logistic regression was used to analyse the potential risk factors such as age, gender,type of AF,duration of AF,echocardiography parameters. Results LAT was present in 3.4% and SEC in 3.6% of patients.All the LAT located in left atrial appendage.Binary Logistic regression analysis, independent risk factors of LAT/SEC included persistent AF and long-standing persistent AF （ OR = 1.7,95% CI 1.1 ± 2. 4） ,female （OR= 1.7,95%CI 1.1±2. 7） ,cardiomyopathy （OR=2. 8,95% CI 1.3-5.7） ,left ventrieular e- jection fraction （LVEF） ± 0. 40 （ OR = 6. 0,95% CI 2.0 ± 18. 2 ）, left atrial diameter （ LAD ） I〉 40 mm （ OR = 7.1,95% CI 4. 4- 11.4）. Conclusion An enlarged LAD and decreased LVEF are the strongest independent risk factors of LAT/SEC.They are may be useful in predicting embolic events in patients with nonvalvular AF.