Haemostatic and haemodynamic abnormalities associated with left atrial thrombosis in non-rheumatic atrial fibrillation
Haemostatic and haemodynamic abnormalities associated with left atrial thrombosis in non-rheumatic atrial fibrillation
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DOI：
10.1136/hrt.77.5.407
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发表时间：
1997-05-01
期刊：
影响因子：
5.7
通讯作者：
Davies, JA
中科院分区：
文献类型：
--
作者：
Heppell, RM;Berkin, KE;Davies, JA
目的：评价止血和血液动力学变量在非风湿性房颤患者左心房血栓形成中的作用。设计-病例-对照研究。受试者-109例非风湿性房颤患者。干预-在左心房三个部位测量峰值血流速度。静脉血凝血蛋白和标记物的止血activation.Main结果measures-Presence左心房血栓和自发回声对比transoseophageal echocardiography.Results-Left心房血栓被确定在19例（18%），其中16人有自发回声对比。有血栓的患者左心耳峰值流速较无血栓的患者降低（0.17 v0.26 m/s; P < 0.001），但左心房中部或二尖瓣流出道峰值流速无明显降低。血栓患者血浆中血小板活化标志物-β-血栓球蛋白水平升高（56.8 vs 30.4 IU/ml; P < 0.001）和血小板因子4（6.1 v 3.5 IU/ml; P < 0.01）-血栓形成：凝血酶-抗凝血酶复合物（5.59 v3.06 μ g/ml; P < 0.001）和D-二聚体（479 v298 ng/ml; P < 0.01）。vonWillebrand因子也升高（1.81 v1.52IU/ml; P < 0.05）。多元逻辑回归模型确定左心耳速度（P = 0.001），β血小板球蛋白（P = 0.002）和von Willebrand因子（P = 0.04）作为左房血栓形成的独立相关因素，先于自发性超声造影的存在。结论：非风湿性房颤患者的左房血栓与止血和血流动力学异常有关，并可能有助于对血栓栓塞风险进行分层。
Objective-To evaluate the role of haemostatic and haemodynamic variables in left atrial thrombosis in non-rheumatic atrial fibrillation.Design-Case-control study.Subjects-One hundred and nine patients with non-rheumatic atrial fibrillation.Interventions-Peak blood velocity measured at three sites in the left atrium. Venous blood sampled for coagulant proteins and markers of haemostatic activation.Main outcome measures-Presence of left atrial thrombus and spontaneous echo contrast at transoesophageal echocardiography.Results-Left atrial thrombus was identified in 19 patients (18%), 16 of whom had spontaneous echo contrast. Patients with thrombus had reduced peak left atrial appendage velocity compared with those without (0.17 v 0.26 m/s; P < 0.001), but no significant reductions in peak mid-left atrial or mitral valve outflow velocity. Patients with thrombus had increased plasma markers of platelet activation-beta thromboglobulin (56.8 v 30.4 IU/ml; P < 0.001) and platelet factor 4 (6.1 v 3.5 IU/ml; P < 0.01)-and of thrombogenesis: thrombin-antithrombin complexes (5.59 v 3.06 mu g/ml; P < 0.001) and D-dimers (479 v 298 ng/ml; P < 0.01). von Willebrand factor was also increased (1.81 v 1.52 IU/ml; P < 0.05). A multiple logistic regression model identified left atrial appendage velocity (P = 0.001), beta thromboglobulin (P = 0.002), and von Willebrand factor (P = 0.04) as the independent associates of left atrial thrombosis, ahead of the presence of spontaneous echo contrast.Conclusions-Haemostatic and haemodynamic abnormalities are associated with left atrial thrombus in nonrheumatic atrial fibrillation, and may help stratify thromboembolic risk.