謝青龍 陳磊 顏麗麗

[關(guān)鍵詞] 左心房容積指數(shù);心房顫動;左心房;左心耳;血栓

[中圖分類號] R541.75? ? ? ? ? [文獻標(biāo)識碼] A? ? ? ? ? [文章編號] 1673-9701（2021）25-0031-04

The value of LAVI in predicting LA/LAA thrombus in patients with AF

XIE Qinglong? ?CHEN Lei? ?YAN Lili

Department of Cardiovascular Medicine， Taizhou Central Hospital （The Affiliated Hospital of Taizhou University）， Taizhou? ?318000， China

[Abstract] Objective To investigate the clinical value of left atrial volume index （LAVI） in predicting left atrial （LA）/left atrial appendage （LAA） thrombus in patients with atrial fibrillation （AF）. Methods A total of 45 patients with AF confirmed as LA/LAA thrombus by transesophageal echocardiography （TEE） admitted to Taizhou Central Hospital from September 2018 to September 2019 were retrospectively analyzed， and they were categorized as the observation group.Another 45 patients with non-thrombotic AF during the same period were categorized as the control group.The data of the two groups were collected and the differences between the data of the two groups were compared. The clinical value of LAVI in predicting LA/LAA thrombus was analyzed， and the clinical factors affecting LA/LAA thrombus were investigated. Results （1）Compared with the control group， the course of AF， [congestive heart failure， hypertension， age ≥75 （doubled）， diabetes， stroke （doubled）， vascular disease， age 65-74， and sex category （female）， CHA2DS2-VASc] score， left atrial volume （LAV）， left anterior descending （LAD）， LAVI and left ventricular anterior wall （LAAW） increased in the observation group， but left ventricular ejection fraction （LVEF） decreased. （2） The area under the curve of the value of LAVI for predicting LA/LAA thrombus （95% CI） was 0.81 （0.71-0.91）， the optimal diagnostic threshold was 29.48 mL/m2， and the sensitivity and specificity （95% CI） were 0.68 （0.55-0.73） and 0.77 （0.69-0.85）， respectively. LAVI， LAD， LAV and the course of AF were associated with LA/LAA thrombus （OR=3.33， 2.24， 1.55 and 1.14）. Conclusion LAVI is a predictor and risk factor for LA/LAA thrombosis.

[Key words] Left atrial volume index; Atrial fibrillation; Left atrium; Left atrial appendage; Thrombus

心房顫動（Atrial fibrillation，AF）影響心功能，增加血栓栓塞的風(fēng)險，預(yù)防和治療房顫所致血栓事件是臨床重點[1-2]。AF引起左心耳（Left atrial appendage，LAA）收縮功能異常、血液淤滯，是血栓危險因素，此外AF時LAA中vW因子表達上調(diào)激活血小板黏附形成血栓[3-4]，LA血栓形成及脫落也是AF患者出現(xiàn)栓塞事件的原因[5]。AF患者往往存在不同程度的LA結(jié)構(gòu)重構(gòu)及形態(tài)改變，結(jié)構(gòu)重構(gòu)表現(xiàn)在心房擴大、心房肌超微結(jié)構(gòu)改變以及間質(zhì)纖維化，形態(tài)改變與LA負(fù)荷壓力過高有關(guān)，為保持結(jié)構(gòu)穩(wěn)定性，LA往往發(fā)生球形重構(gòu)[6-7]，左心房球形度與二尖瓣狹窄患者血栓事件有關(guān)[8]，這與LA對稱性改變有關(guān)，引起血流模式改變、血流淤滯、炎癥反應(yīng)以及血小板激活促進血栓形成[7]。左心房容積指數(shù)（Left atrium volume index，LAVI）是反映左心房重構(gòu)的指標(biāo)，可能與AF患者的栓塞事件有關(guān)。