左房自发性显影的相关因素及临床预测价值的研究

Investigate the related factors and clinical predictive value of left atrial spontaneous echo

目的:探讨经食管超声检查的心房颤动(房颤)患者左房或左心耳自发性显影形成的相关因素,为临床进行风险评估、指导治疗提供依据。方法:选取该院2011-2014年未进行正规华法林抗凝的113例房颤患者,均行经食管超声心动图检查,将符合标准的92例患者根据是否存有左房自发性显影分为LASEC阳性组和LASEC阴性组,回顾性对比分析两组的临床特征及超声心动图参数,对结果进行多因素分析及诊断价值评估。结果:两组间在房颤类型(持续性)、高血压、左心房内径,左室舒张功能中有显著差异(P<0.05),其中持续性房颤、左心房内径>40mm、高血压病有极显著差异(P<0.01)。CHA2DS2-VASC评分、血浆D-二聚体对LASEC的房颤患者有预测价值。结论:持续性房颤患者LASEC的发生率较高,多合并血栓形成(44%)。LASEC形成的影响因素包括:持续性房颤、左心房内径>40mm、高血压、左室舒张功能差;CHA2DS2-VASC评分、D-二聚体对LASEC的形成有临床预测价值。

Objective.. To investigate left atrial or left atrial appendage spontaneous by transesophageal echocar- diography for clinical risk assessment, providing an important basis for guiding treatment. Method.. The 113 atrial fibrillation patients who undertook not have formal warfarin treatment in 2011--2014 were included and undertook transesophageal echocardiography, after excluding substandard patients. The 92 patients of them were divided into LASEC positive group and negative group. We analyzed the clinical features and echocardiographic parameters, then evaluated the diagnostic value and results of multivariate analysis. Result： The study found a significant difference （P〈0.05） between the two groups in the type of AF （continuous AF）,hypertension,left atrial diameter, left ventricular diastolic function, among the factors. Persistent atrial fibrillation, left atrial diameter〉40 mm, and hypertension had extremely significant differences （P〈0.01）. CHA2DS2-VASC score, D-dimer in plas- ma had predictive values for LASEC patients with atrial fibrillation. Conclusion： Patients with persistent AF have a higher LASEC incidence, 44% patients have combined with thrombosis. Factors of LASEC formation include： persistent atrial fibrillation, left atrial diameter〉40mm, hypertension, left ventricular diastolic dysfunction. CHA2DS2-VASC score and D-dimer patients have clinical predictive values for formation of LASEC.