非瓣膜性心房颤动患者左心耳功能异常与血栓形成事件的相关性研究

Correlation between abnormal left atrial appendage function and thrombotic events in patients with non-valvular atrial fibrillation

目的:探讨非瓣膜性心房颤动(房颤)患者左心耳功能异常与血栓形成事件的相关性及影响左心耳功能的独立危险因素。方法:选取2019年6月1日至2021年6月1日期间就诊于新疆医科大学第一附属医院房颤中心的非瓣膜性房颤患者。根据左心耳血流速度(left atrial appendage flow velocity,LAAFV),将研究对象分为左心耳功能正常组(LAAFV≥40 cm/s,297例)和左心耳功能异常组(LAAFV<40 cm/s,85例);收集患者的基线资料,采集所有患者的经食管超声心动图图像。分别记录两组患者血栓事件发生情况。并做单因素及多因素非条件logistic回归,拟探究左心耳功能异常与血栓事件发生的相关性。结果:两组性别、房颤类型、卒中风险评分(CHA 2DS 2-VASc评分)、抗凝药治疗、总胆固醇、低密度脂蛋白胆固醇、国际标准化比值(INR)、左心房内径、右心房增大患者比例、射血分数、左心耳各角度内径及内径之和、深度及深度之和、血栓事件发生率差异均有统计学意义(P值均>0.05)。通过多因素非条件logistic回归调整混杂因素后,左心耳功能异常与血栓形成密切相关(β=1.168 P=0.002),左心房内径[OR(95%CI)为1.084(1.019~1.153),P=0.011]、持续性房颤[OR(95%CI)为2.323(1.226~4.403),P=0.010]是影响左心耳功能的独立危险因素。结论:左心耳功能异常与血栓形成密切相关。左心房内径、持续性房颤是影响左心耳功能的独立危险因素。

Objective To investigate the association between abnormal left atrial appendage function and thrombotic events in patients with non-valvular atrial fibrillation,and the independent risk factors affecting left atrial appendage function.Methods Patients with non-valvular atrial fibrillation,who visited the Atrial Fibrillation Center of the First Affiliated Hospital of Xinjiang Medical University from June 1,2019 to June 1,2021,were selected.According to left atrial appendage flow velocity(LAAFV),they were divided into normal left atrial appendage function group(297 patients with LAAFV≥40 cm/s)and abnormal left atrial appendage function group(85 patients with LAAFV<40 cm/s).Baseline data and transesophageal echocardiography images were collected from all the patients.The occurrence of thrombotic events was recorded.Univariate and multivariate unconditional logistic regression analyses were conducted to investigate the correlation between abnormal left atrial appendage function and the occurrence of thrombotic events.Results There were significant differences in gender,type of atrial fibrillation,CHA2DS2-VASc score,anticoagulant therapy,total cholesterol,low-density lipoprotein cholesterol,international normalized ratio(INR),left atrial diameter,proportion of patients with right atrial enlargement,left ventricular ejection fraction,inner diameter,sum of inner diameter,depth,and sum of depth of all angles of the left atrial appendage,and incidence of thrombotic events between the two groups(all P<0.05).After adjusting for confounders,multivariate unconditional logistic regression analyses showed that abnormal left atrial appendage function was closely associated with thrombotic events(β=1.168 P=0.002),and left atrial diameter(OR=1.084,95%CI 1.019-1.153,P=0.011)and persistent atrial fibrillation(OR=2.323,95%CI 1.226-4.403,P=0.010)were independent risk factors affecting left atrial appendage function.Conclusions Abnormal left atrial appendage function is closely associated with thrombosis.The left atrial diameter and persistent atrial fibrillation were independent risk factors affecting left atrial appendage function.