CHADS_2及CHA_2DS_2-VASc评分对非瓣膜性心房颤动患者左心房/左心耳血栓的预测价值

The predictive value of CHADS_2 and CHA_2DS_2-VASc score in left atrial or left atrial appendage thrombus in patients with non-valvular atrial fibrillation

目的探讨CHADS_2及CHA_2DS_2－VASc评分对非瓣膜性心房颤动（房颤）患者左心房（LA）／左心耳（LAA）血栓的预测价值。方法连续纳入于我院行经食管心脏超声（TEE）检查的房颤患者164例，分为血栓组和非血栓组。记录患者既往病史，根据患者一般资料，计算其CHADS_2及CHA_2DS_2－VASc评分，同时收集患者实验室检查及心脏超声检查等指标，比较2组资料的差别。结果164例患者中，32例（19．5％）经TEE检查存在LA／LAA血栓（血栓组），血栓组患者CHADS_2及CHA_2DS_2－VASc评分高于非血栓组（2．1±1．3 vs 1．0±0．9，3．4±1．8 vs 1．9±1．4，P〈0．01）；2种评分方法结果，卒中低危、中危（≤1分）患者分别有13例（11．9％）和5例（8．8％）存在LA／LAA血栓；多因素Logistic回归分析显示，CHADS_2评分≥2分（OR=3．735，95％CI：1．508～9．251，P=0．004）和CHA_2DS_2－VASc评分≥2分（OR=5．104，95％CI：1．586～16．425，P=0．006）是心房颤动患者LA／LAA血栓形成的独立危险因素；ROC曲线显示，CHADS_2及CHA_2DS_2－VASc评分预测LA／LAA血栓的曲线下面积分别为0．731（95％CI：0．630～0．832，P〈0．001）和0．742（95％CI：0．640～0．843，P〈0．001）。结论CHADS_2及CHA_2DS_2－VASc评分≥2分是房颤患者LA／LAA血栓形成的独立危险因素，2种评分方法预测LA／LAA血栓价值中等；2种评分方法的卒中低危、中危患者仍有LA／LAA血栓形成，且随着危险分层增高，LA／LAA血栓比例增加。

Objective To investigate the predictive value of CHADS_2 and CHA_2DS_2-VASc score in left atrial （LA） or left atrial appendage （LAA） thrombus in patients with non-valvular atrial fibrillation （AF）. Methods A total of 164 consecu- tive non-valvular AF patients confirmed by transesophageal echocardiography （TEE） were included in this study, and were divided into two groups, LA/LAA thrombus group and non LA/LAA thrombus group. The previous history was recorded in two groups of patients. Their CHADS_2 and CHA_2DS_2-VASc scores were calculated based on the general data of two groups. The laboratory examinations and TEE indexes were compared between two gropes. Results Of all patients, the rate of LA/ LAA thrombus was 19.5%. The CHADS_2 and CHA_2DS_2-VASc scores were significantly higher in LA/LAA thrombus group than those of non LA/LAA thrombus group （2.1±1.3 vs 1.0±0.9, 3.4±1.8 vs 1.9± 1.4, P 〈 0.01）. There were 13（11.9%） and 5 （8.8%） patients showed LA/LAA thrombus under low-moderate risk in the two score systems, respectively. Multivariate logis- tic regression analysis showed that CHADS2 score ≥2 points（OR=3.735, 95%CI： 1.508-9.251, P=0.004） and HA_2DS_2-VASc score ≥2 points （0R=5.104, 95% CI 1.586-16.425, P=0.006） were independent risk factors of LA/LAA thrombus. ROC curve showed that AUC of CHADS2 and CHA_2DS_2-VASc scores to predict LA/LAA thrombus were 0.731 （95% CI：0.630- 0.832, P 〈 0.001） and 0.742 （95% CI：0.640- 0.843, P 〈 0.001）, respectively. Conclusion CHADS_2 and CHA_2DS_2-VASc score 〉12 points are independent risk factors of LA/LAA thrombus in patients with non-valvular atrial fibrillation. The pre- dictive values of both score systems are moderate. There are also LA/LAA thrombus in low-moderate risk patients when us- ing the two score systems, and with the increased risk stratification, the rate of LA/LAA thrombus is increased.