左心耳结构复杂性与非瓣膜性心房颤动患者左心耳血栓形成的关系

Association Between Complex Left Atrial Appendage Morphology and Left Atrial Appendage Thrombus Formation in Patients With Nonvalvular Atrial Fibrillation

目的:探讨左心耳结构复杂性与非瓣膜性心房颤动(NVAF)患者左心耳血栓形成的关系。方法:连续入选拟行射频消融术治疗的NVAF患者295例,记录病史资料和化验指标,进行CHA2DS2-VASc评分。行经食道超声心动图和计算机断层扫描血管造影(CTA)检查了解左心耳有、无血栓形成,以此将患者分为血栓组(n=42)和无血栓组(n=253)。应用CT影像后处理系统对左心房CTA影像进行三维重建,获取每例患者的左心耳形态,将左心耳形态分为单纯型和复杂型两类。分析左心耳血栓形成与各项潜在危险因素的关系。结果:血栓组非阵发性心房颤动(76.2%vs 18.2%)、复杂型左心耳比例(66.7%vs 45.1%)显著高于无血栓组(P均<0.01)。此外,血栓组患者的年龄、心房颤动病程、左心房前后径、B型利钠肽、血尿酸、CHA2DS2-VASc评分均大于无血栓组(P均<0.05)。相对于无血栓组,血栓组患者的高血压、糖尿病、冠心病、慢性心力衰竭、脑卒中/短暂性脑缺血发作/血栓栓塞以及血管疾病的患病率更高(P均<0.05)。多因素Logistic回归分析显示,复杂型左心耳(OR=4.129,95%CI:1.413~12.069)、心房颤动病程(OR=1.021,95%CI:1.006~1.036)、非阵发性心房颤动(OR=13.910,95%CI:4.563~42.406)与CHA2DS2-VASc评分(OR=2.580,95%CI:1.115~5.966)均是左心耳血栓形成的独立危险因素(P均<0.05)。结论:复杂型左心耳为NVAF患者左心耳血栓形成的独立危险因素。

Objectives:To investigate the relationship between the structural complexity of left atrial appendage(LAA)and thrombosis in patients with nonvalvular atrial fibrillation(NVAF).Methods:A total of consecutive 295 NVAF patients scheduled for catheter ablation were enrolled in this study,and the medical history and laboratory parameters were recorded.CHA2DS2-VASc score was calculated.The patients were divided into thrombosis group and non-thrombosis group according to the results of LAA thrombosis,which was detected by transesophageal echocardiography and left atrium computed tomography angiography.Through computer LAA three-dimensional reconstruction,LAA morphology was evaluated and patients were divided into simple and complex types.The relationship between LAA thrombosis and various potential risk factors was analyzed.Results:The proportion of non paroxysmal atrial fibrillation(NPAF)and complex LAA in thrombosis group was significantly higher than that in non thrombosis group(P<0.01).Age,atrial fibrillation course,left atrium diameter,B-type natriuretic peptide,serum uric acid and CHA2DS2-VASc scores were significantly higher in thrombosis group than in non-thrombosis group(all P<0.05).The incidence of hypertension,diabetes,coronary heart disease,congestive heart failure,stroke/transient ischemic attack/thromboembolism and vascular diseases were higher in the thrombosis group than in the non-thrombosis group(all P<0.05).Multivariate logistic regression analysis showed that complex LAA(OR=4.129,95%CI:1.413-12.069),atrial fibrillation course(OR=1.021,95%CI:1.006-1.036),NPAF(OR=13.910,95%CI:4.563-42.406)and CHA2DS2-VASc score(OR=2.580,95%CI:1.115-5.966)were independent risk factors of LAA thrombosis(P<0.05).Conclusions:Complex LAA is an independent risk factor for LAA thrombosis in NVAF patients.