非瓣膜性心房颤动患者左心耳结构复杂性与其血栓形成的相关性研究

Association between thrombus formation and structural complexity of the left atrial appendage in patients with nonvalvular atrial fibrillation

目的评估非瓣膜性心房颤动(NVAF)患者左心耳结构复杂性与左心耳血栓形成的关系。方法纳入2018年10至2021年3月于首钢水钢总医院住院的NVAF患者,收集患者人口统计学资料、既往病史、心脏彩超等,进行CHA_(2)DS_(2)-VASc评分,行计算机断层扫描血管造影(CTA)评估患者有无左心耳血栓形成,并根据左心房CTA影像进行三维重建,将左心耳形态分为单纯型和复杂型两类,并以此进行分组。采用多因素Logistic回归分析探讨左心耳结构复杂性与左心耳血栓形成的关系。结果本研究入选218例NVAF患者,其中单纯型左心耳104例,复杂型左心耳组114例。单纯型左心耳组CHA_(2)DS_(2)-VASc评分[(2.4±1.7)分]、脑卒中/短暂性脑缺血发作(TIA)发生率(12.5%)、左心房血栓形成比例(5.8%)、高血压患病率(44.2%)均显著低于复杂型左心耳组[(2.9±1.5)分、27.2%、16.7%、59.6%],差异均有统计学意义(P均<0.05)。多因素Logistic回归分析显示,复杂型左心耳患者左心耳血栓形成风险是简单型左心耳患者的3.506倍(OR=3.506,95%CI:1.125~10.928);此外,充血性心力衰竭(OR=12.552,95%CI:3.225~48.852)、左心房前后径(OR=1.082,95%CI:1.003~1.169)、NYHA心功能分级(OR=2.103,95%CI:1.222~3.622)、CHA_(2)DS_(2)-VASc评分(OR=1.871,95%CI:1.261~2.778)均是左心耳血栓形成的独立危险因素(P均<0.05)。结论复杂型左心耳显著增加NVAF患者左心耳血栓形成风险。

Objective To evaluate the relationship between left atrial appendage(LAA)thrombus formation and structural complexity in patients with nonvalvular atrial fibrillation(NVAF).Methods Patients with NVAF hospitalized between October 2018 and March 2021 at Shougang Shuigang General Hospital were enrolled in this study.Demographic data,medical history,and echocardiography parameters were collected,and CHA_(2)DS_(2)-VASc scores were calculated.Left atrium computed tomography angiography was preformed to detect LAA thrombosis.LAA morphology was evaluated by computerassisted LAA three-dimensional reconstruction.The patients were divided into a simple type group and a complex type group according to the results of LAA morphologies.Multivariate Logistic regression analysis was performed to investigate the relationship between the structural complexity of the LAA and thrombosis.Results A total of 218 patients with NVAF were included in the study,of whom 104 had a simple type LAA,and 114 had a complex type.CHA_(2)DS_(2)-VASc scores[(2.4±1.70)vs(2.9±1.5),P<0.01],the rate of stoke/transient ischemic attack(12.5%vs 27.2%,P<0.01),the incidence of hypertension(44.2%vs 59.6%,P<0.05),and LAA thrombosis rate(5.8%vs 16.7%,P<0.05)were all significantly lower in the simple type group than those in the complex type group.Multivariate logistic regression analysis showed that the risk of LAA thrombosis was 3.506-fold higher in patients with complex type LAA than in those with simple type LAA[odds ratio(OR)=3.506,95%confidence interval(CI):1.125-10.928].Besides,congestive heart failure(OR=12.552,95%CI:3.225-48.852),anteroposterior diameter of the left atrium(OR=1.082,95%CI:1.003-1.169),NYHA heart function grade(OR=2.103,95%CI:1.222-3.622),and CHA_(2)DS_(2)-VASc score(OR=1.871,95%CI:1.261-2.778)were independent risk factors for LAA thrombosis(P<0.05).Conclusion Complex LAA significantly increases the risk of LAA thrombosis in NVAF patients.