CAJ | 학술논문

目的评价左心房直径对非瓣膜病持续性心房颤动(简称房颤)左心房血栓的预测价值.方法在前瞻性建立的数据库中,筛选2007年1月至2010年6月拟行房颤导管消融并完成经食管超声检查的房颤患者.排除标准:阵发性房颤、瓣膜病房颤、深静脉血栓、肺栓塞、服用华法林抗凝、多次消融.共筛选1 524例,入选367例,其中男267例,女100例,年龄26 ～ 89岁,平均年龄(56±11)岁.根据食管超声检查将患者分为左心房血栓组和无血栓组,通过受试者工作特征性曲线(ROC)判断CHA2DS2Vasc评分和左心房直径对左心房血栓的预测价值.Logistic多因素分析确定左心房血栓的独立危险因素.结果左心房血栓32例(8.7％),左心房血栓组左心房直径、左心室舒张末径、左心室收缩末径大于无血栓组,左心房血栓组左心室射血分数低于无血栓组,两组CHA2DS2Vasc评分差异无统计学意义.左心房直径预测左心房血栓ROC曲线下面积为0.656(0.563 ～0.750),其预测左心房血栓的最佳界值为42.5 mm.150例左心房直径≥42.5 mm患者血栓发生率14.0％,显著高于左心房直径＜42.5 mm患者血栓发生率(5.1％,x2=8.888,P=0.003).单因素分析左心房直径≥42.5 mm增加左心房血栓风险(比值比3.05,95％可信区间1.42 ～6.53,P=0.004).左心房直径≥42.5 mm预测左心房血栓敏感度为67.7％,特异度为61.5％.Logistic多因素分析,校正CHA2DS2Vasc评分、左心室舒张末径、左心室收缩末径、左心室射血分数,左心房直径≥42.5 mm(比值比2.77,95％可信区间1.17 ～6.57,P=0.021)是左心房血栓独立预测因素.结论左心房增大是非瓣膜病持续性房颤左心房血栓的独立危险因素.
목적 평개좌심방직경대비판막병지속성심방전동(간칭방전)좌심방혈전적예측개치.방법 재전첨성건립적수거고중,사선2007년1월지2010년6월의행방전도관소융병완성경식관초성검사적방전환자.배제표준:진발성방전、판막병방전、심정맥혈전、폐전새、복용화법림항응、다차소융.공사선1 524례,입선367례,기중남267례,녀100례,년령26 ～ 89세,평균년령(56±11)세.근거식관초성검사장환자분위좌심방혈전조화무혈전조,통과수시자공작특정성곡선(ROC)판단CHA2DS2Vasc평분화좌심방직경대좌심방혈전적예측개치.Logistic다인소분석학정좌심방혈전적독립위험인소.결과 좌심방혈전32례(8.7％),좌심방혈전조좌심방직경、좌심실서장말경、좌심실수축말경대우무혈전조,좌심방혈전조좌심실사혈분수저우무혈전조,량조CHA2DS2Vasc평분차이무통계학의의.좌심방직경예측좌심방혈전ROC곡선하면적위0.656(0.563 ～0.750),기예측좌심방혈전적최가계치위42.5 mm.150례좌심방직경≥42.5 mm환자혈전발생솔14.0％,현저고우좌심방직경＜42.5 mm환자혈전발생솔(5.1％,x2=8.888,P=0.003).단인소분석좌심방직경≥42.5 mm증가좌심방혈전풍험(비치비3.05,95％가신구간1.42 ～6.53,P=0.004).좌심방직경≥42.5 mm예측좌심방혈전민감도위67.7％,특이도위61.5％.Logistic다인소분석,교정CHA2DS2Vasc평분、좌심실서장말경、좌심실수축말경、좌심실사혈분수,좌심방직경≥42.5 mm(비치비2.77,95％가신구간1.17 ～6.57,P=0.021)시좌심방혈전독립예측인소.결론 좌심방증대시비판막병지속성방전좌심방혈전적독립위험인소.
Objective This study sought to investigate the impact of left atrium size on left atrial (LA) thrombus in patients with non-valvular persistent atrial fibrillation (AF).Methods In a prospectively established database,patients with AF underwent transesophageal echocardiography prior to AF ablation were screened from January 2007 to June 2010.Exclusive criteria included paroxysmal AF,vavular AF,deep vein thrombus,pulmonary embolism,on warfarin,redo procedure.Of 1 524 patients,367 patients (male 267,female 100) with age 26-89 (mean 56 ± 11) were enrolled.The patients were divided into LA thrombus group and non-thrombus group.Receptor-operating curves were used to test the value of CHA2DS2Vasc score and LA diameter predicting LA thrombus.Logistic analysis were used to find the independent predictor of LA thrombus.Results Thirty-two (8.7％) patients had LA thrombus.The LA diameter,left ventricular end diastolic diameter,left ventricular end systolic diameter were significantly larger in thrombus group than non-thrombus group.Left ventricular ejection fraction was significantly lower in thrombus group than non-thrombus group.CHA2DS2Vasc score did not differ between the two groups.The area under the receptor-operating curve for LA diameter predicting LA thrombus was 0.656 (0.563-0.750),the best cut-off point was 42.5 mm.The incidence of LA thrombus was significantly higher in patients with LA diameter ≥42.5 mm than those with LA ＜42.5 mm (14.0％ vs.5.1％,x2 =8.888,P =0.003).In univariate analysis,LA diameter ≥42.5 mm increased the risk of LA thrombus with odds ratio 3.05 (95％ confidence interval 1.42-6.53,P =0.004.The sensitivity and specificity of LA diameter ≥ 42.5 mm in predicting LA thrombus were 67.7％ and 61.5％,respectively.In multivariate analysis,after adjustment of CHA2DS2Vasc score,left ventricular end diastolic diameter,left ventricular end systolic diameter,left ventricular ejection fraction,LA diameter ≥42.5 mm was an independent risk factor of LA thrombus (odds ratio 2.77,95％ confidence interval 1.17-6.57,P =0.021).Conclusion LA enlargement is an independent risk factor of LA thrombus in patients with non-vavular persistent AF.