CHA2DS2-VASc评分及MDCT对非瓣膜性房颤患者左心房/左心耳血栓预测价值的临床研究

the Predictive Value of CHA2DS2-VASc Score and MDCT in Left Atrial or Left Atrial Appendage Thrombus Formation with Non-valvular Atrial Fibrillation Patients Undergo CPVA

目的探讨CHA2DS2-VASc评分及MDCT对Nonvalvular AF预行消融术患者左房/左心耳（LA/LAA）血栓形成预测价值。方法整群选取2012年1月—2014年12月期间预行射频消融术房颤患者233例,进行CHA2DS2-VASc评分,经食道心脏彩超及左心房MDCT检查以排除左心房血栓。线性趋势χ^2检验分析CHA2DS2-VASc评分与LA/LAA血栓发生率关系。Mc Nemar法χ^2检验验证左心房MDCT与传统TEE技术一致性。结果 233入选病例中LA/LAA血栓形成13例,CHA2DS2-VASc评分0分组1例,1分组2例,2分组3例,3分组3例,≥4分组4例。0~1分组血栓发生率2.16%,3分以上为16.28%。线性趋势χ^2检验分析提示CHA2DS2-VASc评分与LA/LAA血栓形成有明显统计学意义,P=0.001。TEE法检出血栓8例,左心房MDCT发现3例,Mc Nemar法χ^2检验P=0.062,提示两种方法一致性。结论 CHA2DS2-VASc评分与LA/LAA血栓形相关,评分越高血栓形成风险趋大,伴高血压病、充血性心力衰竭是血栓形成主要危险因素。CHA2DS2-VASc 0分、1分低危组预行消融术患者LA/LAA血栓形成发生率极低。左心房MDCT技术与传统TEE检查有较好一致性。

Objective This study aims to the predictive value of CHA2DS2-VASc scores and MDCT in left atrial/left atrial appendage（LA/LAA） thrombus formation in nonvalvular atrial fibrillation patients undergo circumferential pulmonary vein ablation（ CPVA）. Methods Group selection all datas were collected from those appointed to CPVA with symptomatic nonvalvular atrial fibrillation between January 2012 to December 2014, including CHA2DS2-VASc Scores,Echocardiography,electrocardiography or Holter, chest X-ray,transesophageal echocardiography（TEE）, computed tomography Angiography（MDCT）. Patients were divided into thrombus group and non- thrombus group according to TEE and MDCT. We demonstrated the relationship between CHA2DS2-VASc scores and LA/LAA thrombus formation by linear Chi-square test and the frequency differences of each factor of CHA2DS2-VASc scores in the two groups based on X2–test or Fisher exact test. X2-test（Mc Nemarmethod） was applied to the difference in LA/LAAthrombus formation detection between TEE and MDCT,sensitivity,specificity,positivepredictive value and negative predictive value were calculated due to TEE gold standard. Results13LA/LAA thrombus formation in the study, the morbidity was 2.16%（3/139） in low risk group（CHA2DS2-VASc scores 0,1）,while 16.28%（7/43） in score three or over three classification. In linear Chi-square test,it showed a rising LA / LAA thrombus prevalence by the CHA2DS2-VASc score ranks,P=0.001. there were 3 LA / LAA thrombus formation in MDCT examination,while 8 suspected cases by TEE, X2-test（Mc Nemarmethod） do not detect the difference（P=0.062）. Conclusion It shows a rising thrombus prevalence by the CHA2DS2-VASc score ranks in Non Valvlar AF subjects.the incidence of LA /LAA thrombus Extremely low in CHA2DS2-VASc score zero,one classification.MDCT seems be equivalent to TEE in LA/LAA thrombus detection.