Transesophageal echocardiographic correlates of clinical risk of thromboembolism in nonvalvular atrial fibrillation
Transesophageal echocardiographic correlates of clinical risk of thromboembolism in nonvalvular atrial fibrillation
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DOI：
10.1016/s0735-1097(98)00146-6
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发表时间：
1998-06-01
影响因子：
24
通讯作者：
Hart, RG
中科院分区：
文献类型：
--
作者：
Zabalgoitia, M;Halperin, JL;Hart, RG
目标。本研究通过评估经食道超声心动图(TEE)的相关性，探讨临床和心前区超声心动图预测房颤(AF)血栓栓塞症的机制。非瓣膜性房颤患者血栓栓塞症的临床预测因素已经确定，但其机制联系尚不清楚。TEE提供了左心房、其附件和近端胸主动脉的成像，潜在地阐明了急性房颤患者的中风机制。在阿司匹林治疗期间接受TEE治疗的786名参与者中，横断面分析了TEE特征与低、中、高血栓栓子风险的相关性。与血栓风险增加独立相关的TEE特征是附件血栓(相对危险度RR2.5，p=0.04)、致密的自发回声对比(RR3.7，p<；0.001)、左心耳峰值血流速度20 cm/S(RR1.7，p=0.008)和复杂的主动脉斑块(RR2.1%，p<；0.001)。与低危患者相比，有高血压病史的AP患者更容易出现心耳血栓(RR2.6，p<；0.001)和Wow血流速度减慢(RR1.8，p=0.003)。在低风险患者中，间歇性房颤患者的TEE特征与持续房颤患者相似。在房颤患者中，TEE结果提示心房停滞或血栓形成以及主动脉粥样硬化独立地与血栓栓塞症的高风险相关。与房颤高血压病史相关的卒中风险增加似乎主要通过左房停滞和血栓来调节。复杂的主动脉斑块的存在将高危房颤患者与中等风险血栓栓塞症患者区分开来。(C)1998年由美国心脏病学会颁发。
Objectives. This study explored the mechanisms linking clinical and precordial echocardiographic predictors to thromboembolism in atrial fibrillation (AF) by assessing transesophageal echocardiographic (TEE) correlations.Background. Clinical predictors of thromboembolism ire patients with nonvalvular AF have been identified, but their mechanistic links remain unclear. TEE provides imaging of the left atrium, its appendage and the proximal thoracic aorta, potentially clarifying stroke mechanisms in patients with AF.Methods. Cross-sectional analysis of TEE features correlated with low, moderate and high thromboembolic risk during aspirin therapy among 786 participants undergoing TEE on entry into the Stroke Prevention in Atrial Fibrillation III trial.Results. TEE features independently associated with increased thromboembolic risk were appendage thrombi (relative risk [RR] 2.5, p = 0.04), dense spontaneous echo contrast (RR 3.7, p < 0.001), left atrial appendage peak Wow velocities 20 cm/s (RR 1.7, p = 0.008) and complex aortic plaque (RR 2.1%, p < 0.001). Patients with AP with a history of hypertension (conferring moderate risk) more frequently had atrial appendage thrombi (RR 2.6, p < 0.001) and reduced Wow velocity (RR 1.8, p = 0.003) than low risk patients. Among low risk patients, those with intermittent AF had similar TEE features to those with constant AF.Conclusions. TEE findings indicative of atrial stasis or thrombosis and of aortic atheroma were independently associated with high thromboembolic risk in patients with AF. The increased stroke risk associated with a history of hypertension in AF appears to be mediated primarily through left atrial stasis and thrombi. The presence of complex aortic plaque distinguished patients with AF at high risk from those at moderate risk of thromboembolism. (C) 1998 by the American College of Cardiology.