Prevalence and Clinical Determinants of Left Atrial Appendage Thrombus in Patients With Atrial Fibrillation Before Pulmonary Vein Isolation
Prevalence and Clinical Determinants of Left Atrial Appendage Thrombus in Patients With Atrial Fibrillation Before Pulmonary Vein Isolation
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DOI：
10.1016/j.amjcard.2015.07.055
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发表时间：
2015-11-01
影响因子：
2.8
通讯作者：
Aonuma, Kazutaka
中科院分区：
文献类型：
--
作者：
Nishikii-Tachibana, Makiko;Murakoshi, Nobuyuki;Aonuma, Kazutaka
CHADS（2）评分被认为是房颤（AF）患者卒中/血栓栓塞风险的可靠预测因子。然而，即使在CHADS（2）评分较低（CHADS（2）评分= 0或1）的AF患者中，也可能偶尔发生血栓栓塞。为了研究房颤患者左心耳（LAA）血栓（LAAT）形成的发生率和预测因素，我们研究了2008年至2012年连续543例在肺静脉隔离前接受经食管超声心动图检查的日本房颤患者。所有患者均接受华法林抗凝治疗，并评估其临床和超声心动图特征。543例患者中有35例（6.4%）观察到LAAT，其患病率与患者的CHADS（2）评分明显相关。在CHADS（2）评分较低的338例患者中，7例患者（2.1%）观察到LAAT。通过多变量分析，左心房容积增加（>= 50 ml）、射血分数降低（75 pg/ml）与LAAT患病率增加显著相关，即使在CHADS（2）评分低的患者中也是如此。因此，我们提出了一种新的评分系统来预测LAAT（左房容积50 ml：评分>= 2;射血分数75 pg/ml：评分
The CHADS(2) score is considered a reliable predictor of stroke/thromboembolism risk in patients with atrial fibrillation (AF). However, thromboembolism can occasionally occur even in patients with AF with low CHADS(2) score (CHADS(2) score = 0 or 1). To investigate the incidence and predictors of left atrial appendage (LAA) thrombus (LAAT) formation in patients with AF, we studied consecutive 543 Japanese patients with AF who underwent transesophageal echocardiography before pulmonary vein isolation from 2008 to 2012. All patients were treated with anticoagulation therapy with warfarin, and their clinical and echocardiographic characteristics were evaluated. LAATs were observed in 35 (6.4%) of 543 patients, and the prevalence was clearly correlated with the patient's CHADS(2) scores. Of 338 patients with low CHADS(2) score, LAATs were observed in 7 patients (2.1%). By multivariate analysis, increased left atrial volume (>= 50 ml), decreased ejection fraction (75 pg/ml) were significantly associated with increased prevalence of LAATs, even in patients with low CHADS(2) score. Accordingly, we proposed a new scoring system to predict LAAT (left atrial volume 50 ml: score >= 2; ejection fraction 75 pg/ml: score