不同血栓栓塞危险评分与非瓣膜性心房颤动患者左房血栓和/或自发超声显影的预测价值比较

Predictive value of different thromboembolic risk scores for left atrial thrombus and/or spontaneous echocardiographic contrast in patients with non-valvular atrial fibrillation

目的比较CHADS2、CHA2DS2-VASc、ATRIA及R2-CHADS2评分与非瓣膜性心房颤动(简称房颤)患者左房血栓和/或自发超声显影的预测价值。方法纳入2007年1月至2019年7月在中山大学孙逸仙纪念医院心血管内科住院并行经食管心脏超声检查的非瓣膜性房颤患者,收集临床资料及相关辅助检查结果,并分别行CHADS2、CHA2DS2-VASc、ATRIA及R2-CHADS2评分,计算四种评分在不同得分及血栓栓塞危险分层情况下左房血栓和/或自发超声显影的发生率,比较四种评分预测非瓣膜性房颤患者左房血栓和/或自发超声显影的ROC曲线下面积。结果纳入患者564例,患者年龄为(61.1±10.1)岁,其中63.3%为男性,高血压是最常见的合并疾病,见于49.6%的患者。根据是否存在左房血栓和/或自发超声显影将患者分为血栓组(n=82)及非血栓组(n=482)。CHADS2评分血栓组(1[0,2])高于非血栓组(1[0,1])(P<0.05),CHA2DS2-VASc评分血栓组(2[1,3])高于非血栓组(2[1,2])(P<0.05)。CHADS2评分为0、1、2、3、4分的患者分别有11.06%、13.39%、26.58%、18.52%、16.67%存在左房血栓和/或自发超声显影(P for trend=0.016),分层为低危、中危、高危的患者分别有11.06%、13.39%、23.68%存在左房血栓和/或自发超声显影(P for trend=0.004);CHA2DS2-VASc评分为0、1、2、3、4、5、6分及以上的患者分别有10.81%、10.19%、16.57%、21.05%、21.05%、16.67%、14.29%存在左房血栓和/或自发超声显影(P for trend=0.019),分层为低危、中危、高危的患者分别有8.75%、13.90%、19.35%存在左房血栓和/或自发超声显影(P for trend=0.004);两种评分随着得分或者危险分层的增加,患者左房血栓和/或自发超声显影的发生率也逐渐上升(P<0.05),ATRIA评分及R2-CHADS2评分在两组比较中没有统计学意义且不存在此种变化趋势(P>0.05)。CHADS2评分及CHA2DS2-VASc评分的ROC曲线下面积均为0.586(P<0.05),两种评分方法对左房血栓和/或自发超声显影的预测价值方面没有显著差异。ATRIA评分及R2-CHADS2评分的ROC曲线下面积均为0.562,基于本研究的样本对于左房血栓和/或自发超声显影的诊断价值没有统计学意义(P>0.05)。结论CHADS2评分及CHA2DS2-VASc评分对非瓣膜性心房颤动患者左房血栓和/或自发超声显影的诊断价值相当且有限,ATRIA评分及R2-CHADS2评分在基于本样本的研究中未体现预测价值。

Objective To compare the predictive value of CHADS2,CHA2DS2-VASc,ATRIA and R2-CHADS2 score for left atrial thrombus and/or spontaneous echocardiographic contrast in patients with non-valvular atrial fibrillation.Methods From January 2007 to July 2019,patients with non-valvular atrial fibrillation who underwent transesophageal echocardiography in the Sun Yat-Sen Memorial Hospital were included.Clinical data and relevant examination results were collected,and CHADS2,CHA2DS2-VASc,ATRIA and R2-CHADS2 score were calculated.The predictive value of the four scores for left atrial thrombus and/or spontaneous echocardiographic contrast in patients was compared.Results Five hundred and sixty-four patients were included.The age was(61±10)years,of which 63.3%patients were male,and hypertension was the most common complication,seen in 49.6%of the patients.Patients were divided into thrombus(n=82)and non-thrombus(n=482)groups based on the presence of left atrial thrombus and/or spontaneous echocardiographic contrast.The CHADS2 score in thrombus group(1[0,2])was higher than that in non-thrombus group(1[0,1])(P<0.05),and the CHA2 DS2-VASc score in thrombus group(2[1,3])was higher than that in non thrombus group(2[1,2])(P<005).11.06%,13.39%,26.58%,18.52%and 16.67%patients with CHADS2 score of 0,1,2,3 and 4 had left atrial thrombus and/or spontaneous echocardiographic contrast respectively(Pfor trend=0.016),and 11.06%,13.39%and 23.68%patients with low-risk,moderate-risk and high-risk had left atrial thrombus and/or spontaneous echocardiographic contrast respectively(Pfor trend=0.004).10.81%,10.19%,16.57%,21.05%,21.05%,16.67%and 14.29%patients with CHA2 DS2-VASc score of 0,1,2,3,4,5 and 6 or above had left atrial thrombus and/or spontaneous echocardiographic contrast respectively(P for trend=0.019).Left atrial thrombus and/or spontaneous echocardiographic contrast were present in 8.75%,13.90%and 19.35%patients with low risk,medium risk and high risk respectively(Pfor trend=0.004).With the increase of score or risk stratification,the incidence of left atrial thrombosis and/or spontaneous echocardiography increased gradually(P<0.05).The ATRIA score and R2-CHADS2 score had no statistical significance in the comparison between the two groups and there was no such trend(P>0.05).The area under the ROC curve for both the CHADS2 score and CHA2 DS2-VASc score was 0.586(P<0.05).There was no significant difference between the two scoring methods in the prediction of left atrial thrombus and/or spontaneous echocardiographic contrast.The area under the ROC curve for both the ATRIA score and R2-CHADS2 score was 0.562,and the prediction of left atrial thrombus and/or spontaneous echocardiographic contrast was not statistically significant in this sample-based study(P>0.05).Conclusion The CHADS2 score and CHA2 DS2-VASc score have comparable but limited predictive power for left atrial thrombus and/or spontaneous echocardiographic contrast in patients with non-valvular atrial fibrillation.The ATRIA score and the R2-CHADS2 score did not demonstrate predictive power in this sample-based study.[Chinese Journal of Cardiac Pacing and Electrophysiology,2020,34(6):534-539].