代谢综合征对非瓣膜病性心房颤动左心房或左心耳血栓风险分层的附加效应

Effect of metabolic syndrome on risk stratification of left atrial thrombus formation in patients with nonvalvular atrial fibrillation

目的 代谢综合征（MS）是脑卒中和血栓栓塞事件的危险因素之一.本研究旨在探讨MS对非瓣膜病性心房颤动（NVAF）左心房或左心耳血栓风险分层的附加效应.方法 本研究纳入从2007年4月到2014年4月在中山大学孙逸仙纪念医院住院的共286例NVAF患者,经排除标准的筛选后最终纳入209例患者.所有患者在入选前均未服用抗凝药和降脂药.左心房和左心耳血栓通过经食管超声心动图诊断,血栓的风险分层分别通过CHADS2评分、CHA2DS2-VASc评分、MS评分、CHADS2-MS评分和CHA2DS2-VASc-MS评分来评估.以上各评分对血栓预测能力的差异度以受试者工作曲线的曲线下面积来比较.结果 共39例患者（18.7％）存在左心房或左心耳血栓.MS是NVAF患者左心房或左心耳血栓的独立危险因素（OR=22.773,P=0.003）.上述5个评分指标均可预测血栓形成,但附加了MS评分的CHADS2-MS或CHA2DS2-VASc-MS评分可分别提高CHADS2评分和CHA2DS2-VASc评分对血栓的预测能力（ROC曲线下面积比较：CHADS2-MS对CHADS2：0.792对0.736,P=0.043;CHA2DS2-VASc-MS对CHA2DS2-VASc：0.789对0.728,P=0.049）.此外,MS评分可在脑卒中低危人群（CHADS2或CHA2DS2-VASc=0）中区分出易患血栓的高危患者.结论 MS与NVAF左心房或左心耳血栓有关.与CHADS2或CHA2DS2-VASc评分相比,CHADS2-MS或CHA2DS2-VASc-MS评分更适用于NVAF左心房或左心耳血栓的风险分层.

Objective Metabolic syndrome （MS）is a risk factor of stroke and thromboembolism event.In this study,we investigated the additive effect of MS on left atrial （LA） or left atrial appendage （LAA） thrombus formation in patients with nonvalvular atrial fibrillation（NVAF）.Methods This cross-sectional study enrolled 209 consecutive NVAF patients without prior anticoagulant and lipid-lowering therapy in Sun Yat-sen Memorial Hospital from Apr.2007 to Apr.2014.LA/LAA thrombus was diagnosed by transoesophageal echocardiography（TEE）.Risk assessment of LA/LAA thrombus was performed using the CHADS2 and CHA2DS2-VASc scores,alone and alongside with the additive MS score.The differences of predictive abilities of LA/LAA thrombus for different scoring schemes were compared by receiver operating characteristic （ROC） analysis.Results LA/LAA thrombi were identified in 39 patients （18.7％） through TEE.MS was an independent risk factor of LA/LAA thrombus in NVAF patients （OR =22.773,P =0.003）.All of the CHADS2,CHA2DS2-VASc,MS,CHADS2-MS,and CHA2DS2-VASc-MS scores had an acceptable predictive ability of LA/LAA thrombus formation.Additional MS scores improved predictive ability of the risk of LA/LAA thrombus for the CHADS2 and CHA2DS2-VASc scores（R OC area：CHADS2-MS vs.CHADS2,0.792 vs.0.736,P=0.043;CHA2 DS2-VASc-MS vs.CHA2 DS2-VASc,0.789 vs.0.728,P=0.049）.Furthermore,MS helped to distinguish individuals with high risk of LA/LAA thrombi from traditional low-risk of stroke population （CHADS2 or CHA2DS2-VASc=0）.Conclusions MS is associated with LA/LAA thrombus formation in NVAF patients.Compared with CHADS2 or CHA2DS2-VASc scores,the CHADS2-MS or CHA2DS2-VASc-MS scores are superior in LA/LAA thrombus risk stratification.