肥厚型心肌病心房颤动患者合并心房血栓的临床特征及预后分析

Clinical Characteristics of Atrial Thrombosis in Patients with Hypertrophic Cardiomyopathy and Atrial Fibrillation

目的探讨肥厚型心肌病(hypertrophic cardiomyopathy,HCM)心房颤动(房颤)患者合并心房血栓的临床特征及预后。方法连续回顾性入选2009年1月至2019年12月期间入住我院的214例非瓣膜性房颤(nonvalvular atrial fibrillation,NVAF)合并心房血栓的患者,其中HCM房颤合并心房血栓者39例(HCM组),其他NVAF患者合并心房血栓175例(对照组)。对两组患者进行基线临床特征的比较,并进行随访,比较两组患者血栓消退情况、抗凝药物应用、栓塞事件、出血事件、生存情况的差异。结果HCM组在年龄较轻,合并高血压比例较低,CHA2DS2-VASc评分及CHA2DS2-VASc评分≥2分的患者比例均较低的情况下(P<0.05),既往有脑卒中及栓塞史的比例较高(P=0.041)。HCM组35例(89.7%)完成随访,对照组166例(94.9%)完成随访。中位随访时间38(22,60)个月。HCM组有效抗凝比例高于对照组(77.1%vs 55.4%)(P=0.022)。两组共137例(64.0%)患者完成了血栓复查。中位复查时间为4(3,7)个月。在复查的患者中HCM组11例(42.31%)在复查时血栓未消退,高于对照组24例(21.62%,P=0.044)。随访结束时HCM组与对照组脑卒中及系统性栓塞[3例(8.6%)vs 11例(6.6%)(P=0.715)]、死亡[8例(22.9%)vs21例(12.7%)(P=0.208)]、大出血(P=0.584)未达到统计学差异。结论HCM房颤患者易形成心房血栓及合并脑卒中及系统性栓塞,通过抗凝使血栓消退较一般NVAF人群更难。HCM组给予更积极的抗凝治疗后,降低了脑卒中及系统性栓塞风险。

Objective Objective To investigate the clinical characteristics and prognosis of atrial thrombus in patients with hypertrophic cardiomyopathy(HCM)and atrial fibrillation.Methods A total of 214 patients with nonvalvular atrial fibrillation(NVAF)complicated with atrial thrombosis admitted to our hospital from January 2009 to December 2019 were retrospectively selected,including 39 patients with HCM complicated with atrial thrombosis(HCM group),and 175 patients with other NVAF(control group).The baseline clinical characteristics of the two groups were compared,and the two groups were followed up to compare the differences of thrombotic regression,anticoagulant drug use,embolism events,bleeding events and survival between the two groups.Results The age of HCM group was younger(P=0.002),the proportion of patients with hypertension was lower(P=0.007),the proportion of patients with history of stroke and embolism was higher(P=0.041),CHA2 DS2-VASc score and the proportion of patients with CHA2 DS2-VASc score≥2 were lower(P=0.045,P=0.001).In HCM group,35 cases(89.7%)were followed up.In control group 166 cases(94.9%)were followed up.The median follow-up time was 38 months(22,60).The effective anticoagulant ratio in HCM group was higher than that in control group(77.1%vs 55.4%,P=0.022).A total of 137 patients(64.0%)in both groups completed the reexamination of thrombosis.The median reexamine time was 4(3,7)months.Among the reexamined patients,11 patients(42.31%)in HCM group had no regression of thrombus,which was higher than 24 patients(21.62%)in control group(P=0.044).At the end of follow-up,there was no significant difference between HCM group and control group in stroke and systemic embolism[3 cases(8.6%)vs 11 cases(6.6%),P=0.715],death[8 cases(22.9%)vs 21 cases(12.7%),P=0.208],massive hemorrhage(P=0.584).Conclusion HCM patients with atrial fibrillation are prone to be complicated with stroke and systemic embolism.It is more difficult to make the thrombus subside by anticoagulation than that of other NVAF.More aggressive anticoagulant therapy reduced the risk of stroke and systemic embolism in HCM group.