经食管超声心动图预测左室血栓风险的可行性分析

Feasibility analysis of predicting left ventricular thrombus formation by trans esophageal echocardiography

目的:分析左室血栓患者经食管超声心动图(TEE)特点,并分析TEE检测指标与左室血栓发生的相关性,探讨TEE对预测左室血栓风险的可行性。方法:纳入87例经胸彩超确诊的左室扩大患者,以TEE为金标准诊断左室血栓,并将左室血栓患者纳为观察组(n=16),将其他患者纳为对照组(n=71)。对比2组左室后壁厚度(LVPM)、室间隔厚度(IVS)、左室舒张末期内径(LVIDd)、左室收缩末期内径(LVIDs)、左室射血分数(LVEF)、二尖瓣早期血流峰值(E)、二尖瓣晚期峰值(A)、左心耳最大容积、左心耳最小容积、左心耳容积变化率(LAA-EF)、左心耳最大排空速度、左心耳最大充盈速度、二尖瓣反流量、二尖瓣彩色反流束面积(RJA)、左心房面积(LAA)、心腔构型变化情况及临床一般资料。探讨上述指标与左室血栓发生的相关性,并根据Logistic回归分析结果构建左室血栓的风险评估模型,应用受试者工作曲线(ROC)评价该模型的预测效果。结果:观察组高血压患者占比明显高于对照组、LVIDd明显高于对照组、LVEF明显低于对照组、A明显低于对照组、左心耳最大及最小容积明显高于对照组、LAA-EF明显低于对照组、左心耳最大充盈及排空速度明显低于对照组、二尖瓣反流量明显低于对照组,上述差异均有统计学意义(P<0.05);Logistic回归分析显示LVEF、LAA-EF、二尖瓣反流量是左室血栓发生的独立保护因素(P<0.05);建立左室血栓发生的风险评估模型如下:风险评分=100×[0.9×LVEF+1.1×LAA-EF+0.5×(RJA/LAA)],ROC曲线显示该模型对预测左室血栓有较好的可靠性(P<0.05),当风险评分≤88分时,患者左室血栓风险较高。结论:TEE图像清晰、指标可靠,对预测左室扩大患者左室血栓有良好的适用性。

Objective： To analyze the characteristics of trans esophageal echocardiography（ TEE） in patients with left ventricular thrombus,and to analyze the correlation between indexes detected by TEE and left ventricular thrombus formation,and to explore the feasibility of TEE to predict the risk of left ventricular thrombus formation.Methods： 87 cases of left ventricular enlargement diagnosed by transthoracic echocardiographic guidance were included. TEE was taken as the gold standard for diagnosis of left ventricular thrombus formation,according to the diagnosis,16 cases with left ventricular thrombus were included into the observation group,while the other 71 cases were included into the control group. left ventricular posterior wall（ LVPM）,interventricular septal thickness（ IVS）,left ventricular end diastolic diameter（ LVIDd）,left ventricular end systolic diameter（ LVIDs）,left ventricular ejection fraction（ LVEF）,peak filling velocity in early diastole（ E）,peak filling velocity in atrial contraction（ A）,max volume of left atrial appendage,minimum volume of left atrial appendage,left atrial volume change rate（ LAA-EF）,peak emptying velocity of left atrial appendage,peak filling velocity of left atrial appendage,mitral regurgitation area（ RJA）,left atrial area（ LAA）,changes on heart cavity configuration and basic clinical data in 2 groups were compared. The correlation between indexes above and left ventricular thrombus formation was analyzed. A risk assessment model for left ventricular thrombus formation was made according to Logistic regression analysis,and the value of the model was tested by ROC curve. Results： Patients with hypertension in the observation group were more,LVIDd was higher,LVEF was lower,A was lower,max and minimum volume of left atrial appendage were bigger,LAA-EF was lower,peak emptying and filling velocity of left atrial appendage were slower,flow of mitral regurgitation was less than in the control group. The differences above were statistically significant（ P 0. 05）. Logistic regression analysis showed that LVEF,LAA-EF and mitral regurgitation were the independent protective factors for left ventricular thrombosis（ P 0. 05）. The model for predicting left ventricular thrombus formation was made as follow： Risk score = 100 ×[0. 9 × LVEF ＋ 1. 1 × LAAEF ＋ 0. 5 ×（ RJA/LAA） ]. ROC curve showed that the model has good reliability in predicting left ventricular thrombus formation（ P 0. 05）,when the risk score was less than 88,patients had high risk for left ventricular thrombus formation. Conclusion： TEE is clear and reliable,and can be used in the prediction of left ventricular thrombus formation in patients with left ventricular enlargement.