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.docVIP

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 封盼攀 贾锋鹏 廖慧 顾俊 高凌云 何泉 （重庆医科大学附属第一医院心血管内科，重庆，400016） 摘要：目的　探讨CHA2DS2-VASc评分低危的未经正规华法林抗凝的非瓣膜病房颤患者，射频消融术前是否需要常规的经食道心脏超声检查及CHA2DS2-VASc评分与左房血栓的相关性。方法　分析了212例未经正规华法林抗凝的非瓣膜病房颤患者，射频消融前经食道心脏超声检查发现左房血栓的发生率，以及左房血栓与房颤类型、检查时是否存在房颤、左房内径、左室射血分数、性别、年龄、以及合并高血压、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　经食道心脏超声检查发现左房血栓共33例，其发生率为15.6%。CHA2DS2-VASc ＝0组患者57例（26.9%），左房血栓0例；CHA2DS2-VASc ＝1 组患者61例（28.8%），左房血栓2例，其发生率为3.28%；CHA2DS2-VASc ≥2组患者94例（44.3%），左房血栓31例，其发生率为32.98%，其左房血栓发生率随CHA2DS2-VASc 评分增高而增加，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＞40mm、高血压、糖尿病、冠心病、卒中、CHA2DS2-VASc评分logistic回归 (OR：.637,95%CI：-50.986, P0.05)。TEE检查，未经正规华法林抗凝的低危阵发性房颤患者，也许术前不需要常规进行食道超声检查明确左房血栓是否存在。 关键词:　 心房颤动R541.7　R454.1　R540.4 文献标识码：A Prognostic significance of CHA2DS2-VASc score in the evaluation of left atrial thrombus with transesophageal echocardiography in nonvalvular atrial fibrillation patients before pulmonary vein isolation Feng Panpan，Jia Fengpeng, Liao Hui, Gu Jun, Gao Lingyun, He Quan (Department of Cardiology; the First Affiliated Hospital, Chongqing Medical University, Chongqing，400016,China) Abstract: Objective To investigate if the nonvalvular atrial fibrillation patients with a CHA2DS2-VASc score of 0 ,require a routine screening transesophageal echocardiogram(TEE) before pulmonary vein isolation(PVI),and the relationship of a CHA2DS2-VASc score with LA thrombus. Methods TEEs for pre-PVI of 212 non-warfarin treatment AF patients and the risks of thrombus such as the type of AF, age, sex ,the diameter of LA ,combined hypertension, mellitus diabetes were analysed, the relationship between the left thrombus and the CHA2DS2-VASc score were compared. Results:The rate of LA thrombus identified on TEE in patients with nonvalvular AF referred for pre-PVI was 15.6%(33/212). CHA2DS2-VASc score of 0,1 and ≥2 were present in 26.9%,28.8% and 44.3% of patients, respectively.The prevalence of LA thrombus significantly increased with increasing CHA2DS2-VASc score (s