非瓣膜性心房颤动患者左心房血栓或自发性显影影响因素分析

Influencing factor analysis of left atrial thrombus or spontaneous echo contrast in patients with non-valvular atrial fibrillation

目的探讨非瓣膜性心房颤动（房颤）患者左心房血栓或自发性显影的影响因素。方法连续入选非瓣膜性房颤患者130例,进行CHA2DS2-VASc评分,并记录性别、年龄、伴发疾病、化验指标、超声心动图结果等基线资料。根据食管超声结果分为左心房血栓或自发性显影阳性组和阴性组,比较两组各项指标的差异。Logistic多因素分析确定左心房血栓或自发性显影的独立危险因素。通过受试者工作特征性曲线（ROC）判断CHA2DS2-VASc评分、左心房内径（LAD）、左心耳排空速率及左心耳充盈速率对左心房血栓或自发性显影的预测价值。结果 LAD、左心室舒张末内径（LVEDD）、左心室射血分数（LVEF）、持续性房颤、既往脑卒中或短暂性脑缺血发作（TIA）史、体质量指数（BMI）、CHA2DS2-VASc评分、左心耳排空速率、左心耳充盈速率在两组间差异有统计学意义（P〈0.05）。多因素回归显示,LAD〉40.0mm（P〈0.01）、左心耳排空速率〈54.15cm/s（P〈0.01）、BMI≥25（P〈0.01）与非瓣膜性房颤患者左心房血栓或自发性显影独立相关。LAD的ROC曲线下面积为0.845（95%CI=0.776~0.913,P〈0.01）;左心耳排空速率的ROC曲线下面积分别为0.851（95%CI=0.781~0.921,P〈0.01）。结论左心房内径〉40.0mm、左心耳排空速率〈54.15cm/s是非瓣膜性房颤患者左心房血栓或自发性显影的独立危险因素。

Objective To investigate influencing factors of left atrial thrombus（LATH）or spontaneous echo contrast（SEC）in patients with non-valvular atrial fibrillation（NVAF）.Methods One hundred and thirty patients with NVAF were collected in this study.CHA2DS2-VASc risk scores for each patient were calculated.The baseline clinical data were detected,including gender,age,concomitant diseases,laboratory parameters and ecocardiography.The patients were divided into left atrial thrombus or spontaneous echo contrast positive group and negative group according to the result of transeophageal ecocardiography（TEE）.The parameters between the two groups were compared,receptor-operating curves（AUC）were used to test the value of CHA2DS2-VASc score,left atrial diameter（LAD）,left atrial appendage filling velocity and left atrial appendage emptying velocity predicting left atrial thrombus or spontaneous echo contrast.Logistic analysis was used to find the independent predictor of left atrial thrombus or spontaneous echo contrast.Results There were significant differences in left atrial diameter（LAD）,left ventricular end-diastolic diameter（LVEDD）,left ventricular ejection fraction（LVEF）,the proportion of persistent atrial fibrillation,previous history of stroke or transient ischemic attack（TIA）,body mass index（BMI）,CHA2DS2-VASc score,left atrial appendage emptying velocity,left atrial appendage filling velocity between the two groups.In multivariate analysis,LAD40.0mm（P =0.01）,left atrial appendage emptying velocity54.15cm/s（P 0.01）,BMI≥25（P 0.01）were independently associated with left atrial thrombus or SEC in patients with NVAF.The AUC of LAD to predict left atrial thrombus or SEC was 0.845（95%CI =0.776-0.913,P 0.01）,the sensitivity and specificity were 67.6% and 88.7%.The AUC of left atrial appendage emptying velocity to predict left atrial thrombus or SEC was 0.851（95%CI =0.781-0.921,P 0.01）,the sensitivity and specificity were 83.9% and 74.9%.Conclusion LAD40.0mm,left atrial appendage emptying velocity54.15cm/s are independent risk factors of left atrial thrombus or spontaneous echo contrast in patients with NVAF.