CHA2DS2-VASc评分对非瓣膜病心房颤动患者射频消融前左房血栓的风险评估

Prediction of left atrial thrombi using CHA2DS2-VASc scores in patients with nonvalvular atrial fibrillation before pulmonary vein isolation

目的探讨未经正规华法林抗凝的非瓣膜病心房颤动患者，射频消融术前经食道心脏超声检查左房血栓的发生率，CHA2DS2-VASc不同评分对左房血栓的预测能力。方法分析了212例未经正规华法林抗凝的非瓣膜病心房颤动（atrial fibrillation, AF）患者，经食道心脏超声（transesophageal echocardiography，TEE）检查左房血栓的发生率，左房血栓与左室射血分数、性别、年龄、高血压、糖尿病等危险因素的相关性；分析CHA2DS2-VASc不同评分与左房血栓相关性。结果左房血栓患者33例，其发生率为15.6%。CHA2DS2-VASc 评分低危患者57例，左房血栓0例；中危患者61例，左房血栓2例（ 3.28%）；高危患者94例，左房血栓31例（ 32.98%）。左房血栓发生率随CHA2DS2-VASc 评分增高而增加，低危、中危和高危3组间有明显差异 （P〈0.01）。单变量分析发现年龄≥65岁、左房内径＞40 mm、高血压、糖尿病、冠心病、卒中、CHA2DS2-VASc评分均与左房血栓相关；但多变量logistic回归分析显示，仅CHA2DS2-VASc ≥2 是预测左房血栓较好的指标（OR=7.637, 95%CI：1.144～50.986, P〈0.05）。结论未经正规华法林抗凝的非瓣膜病AF患者左房血栓发生率相对较高，CHA2DS2-VASc评分危险分层与左房血栓密切相关，提示其对AF患者射频消融前TEE检查有筛选价值，高危患者应加强抗凝治疗后仍需TEE检查。

Objective To investigate the predictive value of the CHA2DS2-VASc scores to left atrial （LA） thrombi in the patients with nonvalvular atrial fibrillation （AF） prior to pulmonary vein isolation （PVI）. Methods A total of 212 patients with nonvalvular AF were included in this study. No anticoagulation therapy was given and all patients underwent transesophageal echocardiography （TEE） immediately before PVI. CHA2DS2-VASc score was calculated. Results LA thrombi were identified on TEE in 33 patients （15.6%）. CHA2DS2-VASc score of 0, 1 and ≥2 accounted for 26.9%, 28.8%, and 44.3% of patients, respectively. The prevalence of LA thrombi was significantly increased with CHA2DS2-VASc score [score 0 （0%）, score 1 （3.28%）, and score ≥2 （32.98%）, P〈0.001]. In univariate analysis, age≥65, LA≥40mm, hypertension, diabetes, coronary heart disease, stroke history and CHA2DS2-VASc score were associated with thrombi. In multivariate logistic analysis, however, only CHA2DS2-VASc ≥2 was significantly associated with the presence of LA thrombi （OR=7.637, 95% CI 1.144-50.986, P〈0.05）. Conclusion The risk of LA thrombi in nonvalvular AF patients without anticoagulation is high. High CHA2DS2-VASc score （≥2） is strongly associated with LA thrombi on TEE. Our findings suggest CHA2DS2-VASc may be used for screening of TEE before PVI, and TEE needs to be performed in the high-risk patients after regular anticoagulation.