Objective To determine the risk factors for thromboembolism in lower risk patients with non-valvular atrial fibrillation(AF)and low CHA2DS2-VASc scores,which remain undefined.Methods We retrospectively analyzed the ba...Objective To determine the risk factors for thromboembolism in lower risk patients with non-valvular atrial fibrillation(AF)and low CHA2DS2-VASc scores,which remain undefined.Methods We retrospectively analyzed the baseline clinical characteristics,routine laboratory parameters,and echocardiographic measurements of 705 patients(71.1%male;mean age:52.10±9.64 years)with low CHA2DS2-VASc score(0 or 1;1 point for female sex)out of 1346 consecutive patients with non-valvular AF who underwent transesophageal echocardiography(TEE)at Guangdong Cardiovascular Institute between January 2013 and December 2015.Results Patients with left atrial thrombus(LAT)or spontaneous echo contrast(SEC)on TEE(24/705,4%)showed a higher incidence rate of vascular disease(54.2%vs.32.9%,P=0.045)and non-paroxysmal AF(79.2%vs.29.4%,P<0.001),larger left atrial diameter(43.08±4.59 vs.36.02±5.53 mm,P<0.001),and lower left ventricular ejection fraction(58.23±8.82%vs.64.15±7.14%,P<0.001)than those without.Multivariate logistic regression analysis identified left atrial diameter[odds ratio(OR)=1.171,95%confidence interval(CI):1.084–1.265,P<0.001]and non-paroxysmal AF(OR=3.766,95%CI:1.282–11.061,P=0.016)as independent risk factors for LAT/SEC.In ROC curve analysis,a left atrial dimeter cutoff of 37.5 mm yielded 95.0%sensitivity and 62.7%specificity(AUC:0.847,P<0.0001,95%CI:0.793–0.914).Conclusion In patients with non-valvular AF with low CHA2DS2-VASc score,the presence of LAT or SEC was associated with left atrial enlargement,which had moderate predictive value,and non-paroxysmal AF.展开更多
BACKGROUND Inflammatory indices derived from complete blood tests have been reported to be associated with poor outcomes in patients with atrial fibrillation(AF).The data about the relationship between inflammatory in...BACKGROUND Inflammatory indices derived from complete blood tests have been reported to be associated with poor outcomes in patients with atrial fibrillation(AF).The data about the relationship between inflammatory indices and left atrial appendage thrombus(LAAT)or dense spontaneous echo contrast(SEC)are limited.AIM To explore the value of inflammatory indices for predicting the presence of LAAT or dense SEC in nonvalvular AF patients.METHODS A total of 406 patients with nonvalvular AF who underwent transesophageal echocardiography were included and divided into two groups based on the presence(study group)or absence(control group)of LAAT or dense SEC.Inflammatory indices,including the neutrophil-to-lymphocyte ratio(NLR),platelet–tolymphocyte ratio(PLR),and lymphocyte-to-monocyte ratio(LMR),were calculated from complete blood analysis.The associations of inflammatory indices RESULTS LAAT and dense SEC were detected in 11(2.7%)and 42(10.3%)patients,respectively.The PLR only showed an association with LAAT/dense SEC in the univariate model.Elevated NLR(odds ratio[OR]=1.48,95%confidence interval[CI]:1.11-1.98,P=0.007)and reduced LMR(OR=0.59,95%CI:0.41-0.83,P=0.003)were found to be independent risk factors for the presence of LAAT/dense SEC.The areas under the NLR and LMR curves for predicting LAAT/dense SEC were 0.73(95%CI:0.66-0.80,P<0.001)and 0.73(95%CI:0.65-0.81,P<0.001),respectively,while the cutoff values were 2.8(sensitivity:69.8%;specificity:64.0%)and 2.4(sensitivity:71.7%;specificity:60.6%),respectively.CONCLUSION Increased NLR and decreased LMR may predict LAAT/dense SEC in patients with nonvalvular AF.展开更多
To investigate the relationship between spontaneous echo contrast (SEC) and left atrial appendage (LAA) blood flow velocity using transesophageal echocardiography (TEE) during percutaneous balloon mitral valvotomy (PB...To investigate the relationship between spontaneous echo contrast (SEC) and left atrial appendage (LAA) blood flow velocity using transesophageal echocardiography (TEE) during percutaneous balloon mitral valvotomy (PBMV) in patients with atrial fibrillation and sinus rhythm Methods Thirty five patients (21 in sinus rhythm and 14 in atrial fibrillation ) with rheumatic mitral stenosis underwent PBMV with intraoperative transesophageal echocardiography monitoring We measured LAA blood flow velocities and observed the left atrium for various grades of SEC (from 0=none to 4=severe), before and after each balloon inflation Results Left atrial appendage maximal emptying velocity (LAA MEV) was reduced from 35±14?cm/s to 6±2?cm/s at peak balloon inflation and increased to 40±16?cm/s after balloon deflation Comparison of the values before balloon inflation and after balloon deflation showed that LAA velocities were significantly lower (P<0 001) During balloon inflation, both maximal emptying velocity (MEV) and maximal filling velocity (MFV) were significantly decreased, compared to those before inflation and after balloon deflation (P<0 01) And both MEV and MFV were significantly higher after balloon deflation relative to those before balloon inflation Patients with atrial fibrillation had significantly lower MEV and MFV before and during balloon inflation and after balloon deflation than patients with sinus rhythm At peak balloon inflation, new or increased SEC grades were observed during 54 of 61 (88%) inflations and unchanged during 7 (12%) inflations SEC grades were reduced after 55 balloon deflations (90%), completely disappeared after 18 deflations (30%) and remained unchanged after 6 deflations (10%) At peak balloon inflation,left atrium spontaneous echo contrast (LASEC) grade 4 was observed during 14 of 27 (93%) inflations in the atrial fibrillation patients, significantly higher than in patients with sinus rhythm (8 of 34, 24%; P <0 05) LASEC completely disappeared after 16 of 34 deflations (47%) in the patients with sinus rhythm, significantly higher than in the atrial fibrillation patients (2 of 27 deflations; P <0 01) The mean time to achieve maximal SEC grade (2 5±1 2?s) correlated with the mean time to trough LAA velocities (2 3±1 1?s ) after balloon inflation Both the time to lowest LAA velocity and the time to highest LASEC were significantly longer in the patients with sinus rhythm than in the atrial fibrillation patients (2 6±1 1?s vs 1 7±1 0?s, P<0 05 and 2 8±1 4?s vs 1 9±1 3?s, P<0 05, respectively) Upon deflation, the mean time to lowest SEC grade (2 9±1 8?s) correlated with the mean time to achieve maximal LAA velocities (2 7±1 6?s) Both intervals are significantly shorter in the patients with sinus rhythm than in the atrial fibrillation patients (2 0±1 6?s vs 3 5±1 5?s, P<0 01 and 2 2±1 7?s vs 3 6± 1 6?s, P<0 05) Conclusion Reducing the blood flow velocity in the human left atrium by balloon occlusion of the mitral valve may enhance SEC, whereas restoring blood flow after balloon deflation would cause enhanced echogenic blood to disappear or decrease in both groups of patients Patients with atrial fibrillation demonstrate more severe blood stagnation of the left atrial body and appendage during transient balloon inflation at mitral valve orifice and slower recovery from the stagnation, decreasing to a lesser extent after balloon deflation, when compared to patients with sinus rhythm展开更多
目的分析非瓣膜性心房颤动(nonvalvular atrial fibrillation,NVAF)患者左心房/左心耳(left atrial and left atrial appendage,LA/LAA)自发显影的临床特征,探讨其与左心房内径的关系。方法对2019年11月-2021年1月我院心内科住院的262例...目的分析非瓣膜性心房颤动(nonvalvular atrial fibrillation,NVAF)患者左心房/左心耳(left atrial and left atrial appendage,LA/LAA)自发显影的临床特征,探讨其与左心房内径的关系。方法对2019年11月-2021年1月我院心内科住院的262例NVAF患者的临床资料(包括性别、年龄及高血压、糖尿病、脑卒中或短暂性脑缺血发作、血管疾病病史等)、实验室检查结果(包括凝血功能、血常规、甲功等)及经胸心脏超声测量参数进行数据收集及回顾性分析。根据经食管心动超声结果分为对照组和自发显影组。采用Logistic回归分析LA/LAA自发显影的影响因素。采用ROC曲线评价左心房内径对LA/LAA自发显影的预测价值。结果LA/LAA自发显影的患者中,非阵发性心房颤动所占比例更高(65.9%vs.32.2%,P<0.001),其CHA_(2)DS_(2)-VASc评分显著高于对照组(P=0.003)。与对照组比较,自发显影组左心房内径、左心室收缩末/舒张末内径显著增大,左心室射血分数显著降低,氨基末端脑钠肽前体(NT-proBNP)水平明显升高(P<0.05)。Logistic回归分析显示,非阵发性心房颤动(OR=2.451;95%CI:1.260~4.766;P<0.05)、CHA_(2)DS_(2)-VASc评分(OR=1.236;95%CI:1.023~1.494;P<0.05)、左心房内径(OR=1.086;95%CI:1.019~1.157;P<0.05)是LA/LAA自发显影的独立影响因素。ROC曲线评价左心房内径预测LA/LAA自发显影的曲线下面积为0.731(95%CI:0.668~0.794;P<0.001)。结论左心房内径与NVAF患者LA/LAA自发显影密切相关,结合心房颤动类型、CHA_(2)DS_(2)-VASc评分,对NVAF患者血栓栓塞风险具有潜在预测价值。展开更多
基金This work was supported by National Key R&D Program of China(No.2018YFC1312501 and No.2018YFC1312502)Key R&D Program of Guangdong Province,China(No.2019B020230004).
文摘Objective To determine the risk factors for thromboembolism in lower risk patients with non-valvular atrial fibrillation(AF)and low CHA2DS2-VASc scores,which remain undefined.Methods We retrospectively analyzed the baseline clinical characteristics,routine laboratory parameters,and echocardiographic measurements of 705 patients(71.1%male;mean age:52.10±9.64 years)with low CHA2DS2-VASc score(0 or 1;1 point for female sex)out of 1346 consecutive patients with non-valvular AF who underwent transesophageal echocardiography(TEE)at Guangdong Cardiovascular Institute between January 2013 and December 2015.Results Patients with left atrial thrombus(LAT)or spontaneous echo contrast(SEC)on TEE(24/705,4%)showed a higher incidence rate of vascular disease(54.2%vs.32.9%,P=0.045)and non-paroxysmal AF(79.2%vs.29.4%,P<0.001),larger left atrial diameter(43.08±4.59 vs.36.02±5.53 mm,P<0.001),and lower left ventricular ejection fraction(58.23±8.82%vs.64.15±7.14%,P<0.001)than those without.Multivariate logistic regression analysis identified left atrial diameter[odds ratio(OR)=1.171,95%confidence interval(CI):1.084–1.265,P<0.001]and non-paroxysmal AF(OR=3.766,95%CI:1.282–11.061,P=0.016)as independent risk factors for LAT/SEC.In ROC curve analysis,a left atrial dimeter cutoff of 37.5 mm yielded 95.0%sensitivity and 62.7%specificity(AUC:0.847,P<0.0001,95%CI:0.793–0.914).Conclusion In patients with non-valvular AF with low CHA2DS2-VASc score,the presence of LAT or SEC was associated with left atrial enlargement,which had moderate predictive value,and non-paroxysmal AF.
基金We appreciated Xuan Jiang for the statistical analysis. This work was supported by National Nature Science Foundation of China （No.81370295）, Science and Technology Program of Guangdong Province, China （No. 2017A02 0215054）, Science and Technology Planning of Guangzhou City, China （No.2014B070705005）. The authors declared no potential conflicts of interest with respect to the research, authorship or publication of this article.
文摘ObjectiveTo 在左 atrial 血栓( LAT )或左 atrial 上评估红房间分发宽度( RDW )的预兆的价值在有纤维性颤动( AF ) .MethodsWe 考察了的非瓣膜的 atrial 的病人的自发的回响对比( LASEC )作为非瓣膜的 AF 被诊断并且经历了 transesophageal echocardiography ( T )在里面的 692 个病人从2014年4月的广东心血管的研究所到2015年12月。基线临床的特征，血常规的实验室测试，心动电流描记器大小是 analyzed.ResultsEighty -- 四个病人在 T 下面与 LAT/LASEC 被检查。吝啬的 RDW 水平与 non-LAT/LASEC 病人相比在 LAT/LASEC 病人是显著地更高的(13.59%
基金Public Welfare Technology Project of Ningbo Science and Technology Bureau,No.2023S140Medical Health Science and Technology Project of Zhejiang Province Health Commission,No.2024KY1518.
文摘BACKGROUND Inflammatory indices derived from complete blood tests have been reported to be associated with poor outcomes in patients with atrial fibrillation(AF).The data about the relationship between inflammatory indices and left atrial appendage thrombus(LAAT)or dense spontaneous echo contrast(SEC)are limited.AIM To explore the value of inflammatory indices for predicting the presence of LAAT or dense SEC in nonvalvular AF patients.METHODS A total of 406 patients with nonvalvular AF who underwent transesophageal echocardiography were included and divided into two groups based on the presence(study group)or absence(control group)of LAAT or dense SEC.Inflammatory indices,including the neutrophil-to-lymphocyte ratio(NLR),platelet–tolymphocyte ratio(PLR),and lymphocyte-to-monocyte ratio(LMR),were calculated from complete blood analysis.The associations of inflammatory indices RESULTS LAAT and dense SEC were detected in 11(2.7%)and 42(10.3%)patients,respectively.The PLR only showed an association with LAAT/dense SEC in the univariate model.Elevated NLR(odds ratio[OR]=1.48,95%confidence interval[CI]:1.11-1.98,P=0.007)and reduced LMR(OR=0.59,95%CI:0.41-0.83,P=0.003)were found to be independent risk factors for the presence of LAAT/dense SEC.The areas under the NLR and LMR curves for predicting LAAT/dense SEC were 0.73(95%CI:0.66-0.80,P<0.001)and 0.73(95%CI:0.65-0.81,P<0.001),respectively,while the cutoff values were 2.8(sensitivity:69.8%;specificity:64.0%)and 2.4(sensitivity:71.7%;specificity:60.6%),respectively.CONCLUSION Increased NLR and decreased LMR may predict LAAT/dense SEC in patients with nonvalvular AF.
文摘To investigate the relationship between spontaneous echo contrast (SEC) and left atrial appendage (LAA) blood flow velocity using transesophageal echocardiography (TEE) during percutaneous balloon mitral valvotomy (PBMV) in patients with atrial fibrillation and sinus rhythm Methods Thirty five patients (21 in sinus rhythm and 14 in atrial fibrillation ) with rheumatic mitral stenosis underwent PBMV with intraoperative transesophageal echocardiography monitoring We measured LAA blood flow velocities and observed the left atrium for various grades of SEC (from 0=none to 4=severe), before and after each balloon inflation Results Left atrial appendage maximal emptying velocity (LAA MEV) was reduced from 35±14?cm/s to 6±2?cm/s at peak balloon inflation and increased to 40±16?cm/s after balloon deflation Comparison of the values before balloon inflation and after balloon deflation showed that LAA velocities were significantly lower (P<0 001) During balloon inflation, both maximal emptying velocity (MEV) and maximal filling velocity (MFV) were significantly decreased, compared to those before inflation and after balloon deflation (P<0 01) And both MEV and MFV were significantly higher after balloon deflation relative to those before balloon inflation Patients with atrial fibrillation had significantly lower MEV and MFV before and during balloon inflation and after balloon deflation than patients with sinus rhythm At peak balloon inflation, new or increased SEC grades were observed during 54 of 61 (88%) inflations and unchanged during 7 (12%) inflations SEC grades were reduced after 55 balloon deflations (90%), completely disappeared after 18 deflations (30%) and remained unchanged after 6 deflations (10%) At peak balloon inflation,left atrium spontaneous echo contrast (LASEC) grade 4 was observed during 14 of 27 (93%) inflations in the atrial fibrillation patients, significantly higher than in patients with sinus rhythm (8 of 34, 24%; P <0 05) LASEC completely disappeared after 16 of 34 deflations (47%) in the patients with sinus rhythm, significantly higher than in the atrial fibrillation patients (2 of 27 deflations; P <0 01) The mean time to achieve maximal SEC grade (2 5±1 2?s) correlated with the mean time to trough LAA velocities (2 3±1 1?s ) after balloon inflation Both the time to lowest LAA velocity and the time to highest LASEC were significantly longer in the patients with sinus rhythm than in the atrial fibrillation patients (2 6±1 1?s vs 1 7±1 0?s, P<0 05 and 2 8±1 4?s vs 1 9±1 3?s, P<0 05, respectively) Upon deflation, the mean time to lowest SEC grade (2 9±1 8?s) correlated with the mean time to achieve maximal LAA velocities (2 7±1 6?s) Both intervals are significantly shorter in the patients with sinus rhythm than in the atrial fibrillation patients (2 0±1 6?s vs 3 5±1 5?s, P<0 01 and 2 2±1 7?s vs 3 6± 1 6?s, P<0 05) Conclusion Reducing the blood flow velocity in the human left atrium by balloon occlusion of the mitral valve may enhance SEC, whereas restoring blood flow after balloon deflation would cause enhanced echogenic blood to disappear or decrease in both groups of patients Patients with atrial fibrillation demonstrate more severe blood stagnation of the left atrial body and appendage during transient balloon inflation at mitral valve orifice and slower recovery from the stagnation, decreasing to a lesser extent after balloon deflation, when compared to patients with sinus rhythm
文摘目的分析非瓣膜性心房颤动(nonvalvular atrial fibrillation,NVAF)患者左心房/左心耳(left atrial and left atrial appendage,LA/LAA)自发显影的临床特征,探讨其与左心房内径的关系。方法对2019年11月-2021年1月我院心内科住院的262例NVAF患者的临床资料(包括性别、年龄及高血压、糖尿病、脑卒中或短暂性脑缺血发作、血管疾病病史等)、实验室检查结果(包括凝血功能、血常规、甲功等)及经胸心脏超声测量参数进行数据收集及回顾性分析。根据经食管心动超声结果分为对照组和自发显影组。采用Logistic回归分析LA/LAA自发显影的影响因素。采用ROC曲线评价左心房内径对LA/LAA自发显影的预测价值。结果LA/LAA自发显影的患者中,非阵发性心房颤动所占比例更高(65.9%vs.32.2%,P<0.001),其CHA_(2)DS_(2)-VASc评分显著高于对照组(P=0.003)。与对照组比较,自发显影组左心房内径、左心室收缩末/舒张末内径显著增大,左心室射血分数显著降低,氨基末端脑钠肽前体(NT-proBNP)水平明显升高(P<0.05)。Logistic回归分析显示,非阵发性心房颤动(OR=2.451;95%CI:1.260~4.766;P<0.05)、CHA_(2)DS_(2)-VASc评分(OR=1.236;95%CI:1.023~1.494;P<0.05)、左心房内径(OR=1.086;95%CI:1.019~1.157;P<0.05)是LA/LAA自发显影的独立影响因素。ROC曲线评价左心房内径预测LA/LAA自发显影的曲线下面积为0.731(95%CI:0.668~0.794;P<0.001)。结论左心房内径与NVAF患者LA/LAA自发显影密切相关,结合心房颤动类型、CHA_(2)DS_(2)-VASc评分,对NVAF患者血栓栓塞风险具有潜在预测价值。
