CAJ | 학술논문

目的探讨左心房(LA)及左心耳(LAA)形态学指标对CHADS2评分≤1分的心房颤动(房颤)患者血栓栓塞风险的评估价值.方法连续入选2011年5月至2015年1月就诊于首都医科大学附属北京朝阳医院房颤中心拟行导管消融术的房颤患者562例.其中年龄≥18岁、CHADS2评分≤1分,且经食管超声心动图证实存在LAA血栓的患者25例作为A组,根据A组的年龄、性别及CHADS2评分按1∶3的比例匹配75例房颤患者作为B组.B组患者既往无脑卒中史,同时经食管超声心动图证实LAA无血栓形成.所有患者[年龄(60.2±8.5)岁,男性占84.0％]术前均行LA肺静脉双源螺旋CT检查.比较两组患者的LA及LAA解剖形态学指标.结果 A组非鸡翅型形态(22例,88.0％)较B组(46例,61.3％)增多(P=0.013).与B组相比,A组患者的LA容积[(153.3±58.3)ml对(107.1±35.8)ml,P=0.001]及LA/LAA容积比值(16.1±7.2对13.0±6.5,P=0.043)均显著增大.多因素Logistic回归分析显示,非鸡翅型LAA形态及LA容积为CHADS2评分≤1分的房颤患者发生血栓栓塞事件的独立预测因素,两者在Logistic多元回归模型中的ROC曲线下面积为0.790.结论非鸡翅型LAA形态可能与CHADS2评分≤1分的房颤患者的血栓栓塞风险增加相关;同时,较大的LA容积也是增加血栓栓塞风险的因素.
목적 탐토좌심방(LA)급좌심이(LAA)형태학지표대CHADS2평분≤1분적심방전동(방전)환자혈전전새풍험적평고개치.방법 련속입선2011년5월지2015년1월취진우수도의과대학부속북경조양의원방전중심의행도관소융술적방전환자562례.기중년령≥18세、CHADS2평분≤1분,차경식관초성심동도증실존재LAA혈전적환자25례작위A조,근거A조적년령、성별급CHADS2평분안1∶3적비례필배75례방전환자작위B조.B조환자기왕무뇌졸중사,동시경식관초성심동도증실LAA무혈전형성.소유환자[년령(60.2±8.5)세,남성점84.0％]술전균행LA폐정맥쌍원라선CT검사.비교량조환자적LA급LAA해부형태학지표.결과 A조비계시형형태(22례,88.0％)교B조(46례,61.3％)증다(P=0.013).여B조상비,A조환자적LA용적[(153.3±58.3)ml대(107.1±35.8)ml,P=0.001]급LA/LAA용적비치(16.1±7.2대13.0±6.5,P=0.043)균현저증대.다인소Logistic회귀분석현시,비계시형LAA형태급LA용적위CHADS2평분≤1분적방전환자발생혈전전새사건적독립예측인소,량자재Logistic다원회귀모형중적ROC곡선하면적위0.790.결론 비계시형LAA형태가능여CHADS2평분≤1분적방전환자적혈전전새풍험증가상관;동시,교대적LA용적야시증가혈전전새풍험적인소.
Objective We aimed to explore the relationship of anatomical and morphological characteristics of left atrial(LA) and left atrial appendage(LAA) and the thromboembolic risk in patients with atrial fibrillation(AF) and CHADS2 score ≤ 1.Methods In this study,100 patients with non-valvular AF were enrolled [age,(60.2± 8.5) years;male,84.0％] and divided into 2 groups.In group A,all 25 patients met all of the following inclusion criteria:① ≥ 18 years;②CHADS2 ≤ 1 before the index stroke;③ the presence of thrombus in LAA revealed by transesophageal echocardiography(TEE).Group B comprised of 75 AF patients with age-and gender-matched and met all the above criteria excepting the history of ischemic stroke and the presence of LAA thrombus.All patients underwent preprocedural cardiac dual source computed tomography (DSCT) and TEE.Anatomical and morphological characteristics of LA and LAA were compared between the two groups.Results Non-Chicken Wing LAA morphology in group A was more than that in group B [22 (88.0％) vs.46(61.3％),P=0.013].Compared with group B,LA volume and LA/LAA volume ratio were significantly larger in group A [(153.3±58.3) ml vs.(107.1 ±35.8) ml,P=0.001;16.1 ± 7.2 vs.13.0± 6.5,P =0.043,respectively].Using logistic regression model,LA volume and non-Chicken Wing LAA morphology were independently associated with thromboembolic events.The area under the ROC curve was 0.790.Conclusion Non-Chicken Wing LAA morphology may be associated with an increased risk of thromboembolism in patients with AF and CHADS2 score≤ 1.Larger LA volume may also increase the potential thromboembolic risk in these patients.