不同评分系统对非瓣膜性心房颤动患者左心耳血栓状态的预测效果研究

Study on predictive effect of different scoring systems on left atrial appendage thrombotic status in patients with nonvalvular atrial fibrillation

目的探讨不同评分系统在预测非瓣膜性心房颤动(NVAF)患者左心耳血栓状态(LAATM)上的差异。方法选取2015年1月1日至2020年12月31日在该院住院并完成经食管超声心动图(TEE)的NVAF患者为研究对象,根据TEE结果将其分为LAATM组和非LAATM组。收集患者的一般资料(包括性别、年龄、合并疾病等),所有患者均采用CHA_(2)DS_(2)-VASc评分、CHA_(2)DS_(2)-VASc-RAF评分、CHA_(2)DS_(2)-VASc-60评分及ABC卒中评分进行评价,分析不同评分系统对LAATM的预测价值。结果共纳入1217例NVAF患者,其中男647例、女570例。持续性心房颤动529例,阵发性心房颤动688例。TEE示LAATM患者112例,非LAATM患者1105例。LAATM组患者年龄,持续性心房颤动、吸烟、糖尿病、冠心病、卒中/短暂性脑缺血发作(TIA)、他汀发生率,N末端B型利钠肽原(NT-proBNP)、估算肾小球滤过率(eGFR)等均高于非LAATM组,差异有统计学意义(P<0.05)。4种评分系统中,高危评分人群的LATTM检出率均为最高。ABC卒中评分受试者工作特征(ROC)曲线下面积(0.826)高于其他3种评分(0.741、0.688、0.658),差异有统计学意义(P<0.05)。在持续性心房颤动患者中,ABC卒中评分的ROC曲线下面积(0.836)高于其他3种评分(0.793、0.763、0.724),差异有统计学意义(P<0.05);在阵发性心房颤动患者中,ABC卒中评分ROC曲线下面积(0.764)高于其他3种评分(0.742、0.686、0.635),差异有统计学意义(P<0.05)。结论CHA_(2)DS_(2)-VASc评分、CHA_(2)DS_(2)-VASc-RAF评分、CHA_(2)DS_(2)-VASc-60评分及ABC卒中评分均对LAATM有一定的预测价值,其中ABC卒中评分的预测价值高于其他3种评分。

Objective To investigate the differences in different scoring systems in predicting left atrial appendage thrombotic status(LAATM)in the patients with nonvalvular atrial fibrillation(NVAF).Methods The NVAF inpatients with transesophageal echocardiography(TEE)treated in this hospital from January 1,2015 to December 31,2020 were selected as the study subjects and divided into the LAATM group and non-LAATM group according to the TEE results.The general data of the patients were collected,including the sex,age,complicating disease,etc.All patients conducted the scoring by the CHA_(2)DS_(2)-VASc score,CHA_(2)DS_(2)-VASc-RAF score,CHA_(2)DS_(2)-VASc-60 score and ABC stroke score.The predictive value of different scoring systems on LAATM was analyzed.Results A total of 1217 patients with NVAF were enrolled in this study,including 647 males and 570 females.There were 529 cases of persistent atrial fibrillation,688 cases of paroxysmal atrial fibrillation,TEE showed 112 cases of LAATM and 1105 cases of non-LAATM.The age,incidence of persistent atrial fibrillation,incidence of smoking,incidence of diabetes,incidence of coronary heart disease,incidence of stroke/TIA,incidence of statin,N terminal pro-B type natriuretic peptide(NT-proBNP)and estimated glomerular filtration rate(eGFR)in the LAATM group were higher than those in the non-LAATM group,and the differences were statistically significant(P<0.05).In 4 kinds of scoring systems,the LATTM detection rate in the population with high risk scores was the highest.The area under the ROC curve of the ABC stroke score(0.826)was higher than that in the other scores(0.741,0.688,0.658),and the differences were statistically significant(P<0.05).In the patients with persistent atrial fibrillation,the area under the ROC curve of ABC stroke score(0.836)was higher than that of the other three scores(0.793,0.763,0.724,P<0.05),and in the patients with paroxysmal atrial fibrillation,the area under the ROC curve of ABC stroke score(0.764)was higher than that of the other three scores(0.742,0.686,0.635),and the differences were statistically significant(P<0.05).Conclusion CHA_(2)DS_(2)-VASc score,CHA_(2)DS_(2)-VASc-RAF score,CHA_(2)DS_(2)-VASc-60 score and ABC stroke score all have certain predictive value for LAATM,in which the predictive value of ABC stroke score is higher than that of the other three scores.