CHA2DS2-VASc评分对非瓣膜病房颤患者射频消融前左房血栓的风险评估.docVIP

CHA2DS2-VASc评分对非瓣膜病心房颤动患者射频消融前左房血栓的风险评估 封盼攀，贾锋鹏，顾 俊，高凌云，何 泉，吕 斐（400016重庆, 重庆医科大学附属第一医院心血管内科） [摘要] 目的　探讨未经正规华法林抗凝的非瓣膜病心房颤动患者，射频消融术前经食道心脏超声检查左房血栓的发生率， CHA2DS2-VASc不同评分对左房血栓的预测能力。方法　分析了212例未经正规华法林抗凝的非瓣膜病心房颤动（atrial fibrillation, AF）患者，经食道心脏超声(transesophageal echocardiography，TEE)检查左房血栓的发生率，左房血栓与左室射血分数、性别、年龄、高血压、糖尿病等危险因素的相关性；分析CHA2DS2-VASc不同评分与左房血栓相关性。结果　左房血栓患者33例，其发生率为15.6%。CHA2DS2-VASc 评分低危患者57例，左房血栓0例；中危患者61例，左房血栓2例( 3.28%)；高危患者94例，左房血栓31例( 32.98%)。左房血栓发生率随CHA2DS2-VASc 评分增高而增加，低危、中危和高危3组间有明显差异 (P﹤0.01)。单变量分析发现年龄≥65岁、左房内径＞40 mm、高血压、糖尿病、冠心病、卒中、CHA2DS2-VASc评分均与左房血栓相关；但多变量logistic回归分析显示，仅CHA2DS2-VASc ≥2 是预测左房血栓较好的指标(OR=7.637, 95%CI：1.144～50.986, P0.05)。结论 未经正规华法林抗凝的非瓣膜病AF患者左房血栓发生率相对较高，CHA2DS2-VASc评分危险分层与左房血栓密切相关，提示其对AF患者射频消融前TEE检查有筛选价值，高危患者应加强抗凝治疗后仍需TEE检查。 [关键词] 心房颤动；左房血栓；肺静脉电隔离；经食道心脏超声；CHA2DS2-VASc 评分； [中图法分类号] R541.7；R454.1；R540.4 [文献标志码] A Prediction of left atrial thrombi using CHA2DS2-VASc scores in patients with nonvalvular atrial fibrillation before pulmonary vein isolation Feng Panpan, Jia Fengpeng, Gu Jun, Gao Lingyun, He Quan, Lv Fei (Department of Cardiovascular Medicine, the First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China) [Abstract] Objective This study was aimed at investigating the predictive value of the CHA2DS2-VASc scores to left atrial (LA) thrombi in the patients with nonvalvular atrial fibrillation (AF) prior to pulmonary vein isolation (PVI). Methods A total of 212 patients with nonvalvular AF were included in this study. No anticoagulation therapy was given and all patients underwent transesophageal echocardiogram (TEE) immediately before PVI. CHA2DS2-VASc score was calculated. Results LA thrombi were identified on TEE in 33 patients (15.6%). CHA2DS2-VASc score of 0, 1 and ≥2 accounted for 26.9%, 28.8%, and 44.3% of patients, respectively. The prevalence of LA thrombi was significantly increased with CHA2DS2-VASc score (score 0 [0%], score 1 [3.28%], and score ≥2 [32.98%], P0.001). In univariate anal