Association between left atrial appendage fibrosis and thrombus formation: A histological approach
Association between left atrial appendage fibrosis and thrombus formation: A histological approach
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DOI：
10.1111/jce.15384
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发表时间：
2022-01-30
影响因子：
2.7
通讯作者：
Nakano, Yukiko
中科院分区：
文献类型：
--
作者：
Miyauchi, Shunsuke;Tokuyama, Takehito;Nakano, Yukiko
虽然最近的超声心动图研究表明左心耳（LAA）重构有助于左心耳血栓（LAAT）的形成，但缺乏组织学证据。本研究的目的是检查临床参数和组织学结果，以阐明参与LAAT形成的因素。方法选取术中行房颤切除的64例患者（无房颤22例，阵发性房颤16例，非阵发性房颤26例）。术前行经胸、经食管超声心动图检查。我们比较了LAAT患者与非LAAT患者在Azan-Mallory染色下切除LAA切片的纤维化负担（%）。结果阵发性和非阵发性房颤患者的LAA纤维化负担高于无房颤患者（p = 0.005和p < 0.0001）。登记的患者中,16 LAAT, 15人非突发性房颤。非突发性房颤患者中,那些LAAT LAA纤维化负担明显高于那些没有(23.8%(14.8% - -40.3%)和12.8% (7.4% - -18.2%),p = 04)和超声心动图参数的左心室容积指数(R = 0.543, p = . 01), LAA深度(R = 0.452, p = .02点),和LAA流速(R = - 0.487, p = . 01)与LAA纤维化负担。结论本研究提供了LAA纤维化与LAAT形成有关的组织学证据。LAA重构及功能超声心动图参数与LAA纤维化负荷相关。
Introduction Although recent echocardiographic studies have suggested that left atrial appendage (LAA) remodeling contributes to the development of LAA thrombus (LAAT), histological evidence is absent. The objective of this study was to examine clinical parameters and histological findings to clarify the factors involved in LAAT formation. Methods A total of 64 patients (no atrial fibrillation [AF], N = 22; paroxysmal AF, N = 16; nonparoxysmal AF, N = 26) who underwent LAA excision during surgery were enrolled. Transthoracic and transesophageal echocardiography were performed before surgery. We evaluated the fibrosis burden (%) in the excised LAA sections with Azan-Mallory staining in patients with a LAAT compared with those without. Results Patients with paroxysmal and non-paroxysmal AF had a higher LAA fibrosis burden than those without AF (p = .005 and p < .0001, respectively). Among the patients enrolled, 16 had a LAAT and 15 of them had nonparoxysmal AF. Among the nonparoxysmal AF patients, those with a LAAT had significantly higher LAA fibrosis burden than those without (23.8% [14.8%-40.3%] vs. 12.8% [7.4%-18.2%], p = .004) and echocardiographic parameters of the left atrial volume index (R = 0.543, p = .01), LAA depth (R = 0.452, p = .02), and LAA flow velocity (R = - 0.487, p = .01) were correlated with the LAA fibrosis burden. Conclusion This study provided histological evidence that LAA fibrosis is related to LAAT formation. Echocardiographic parameters of LAA remodeling and function were correlated with the LAA fibrosis burden.