左心房容积指数（ ＬＡＶＩ ）预测房颤（ ＡＦ ）患者左心房（ ＬＡ ）/左心耳（ ＬＡＡ ）血栓的价值

谢青龙 陈磊 颜丽丽

[关键词] 左心房容积指数;心房颤动;左心房;左心耳;血栓

[中图分类号] R541.75          [文献标识码] A          [文章编号] 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

心房顫动（Atrial fibrillation，AF）影响心功能，增加血栓栓塞的风险，预防和治疗房颤所致血栓事件是临床重点[1-2]。AF引起左心耳（Left atrial appendage，LAA）收缩功能异常、血液淤滞，是血栓危险因素，此外AF时LAA中vW因子表达上调激活血小板黏附形成血栓[3-4]，LA血栓形成及脱落也是AF患者出现栓塞事件的原因[5]。AF患者往往存在不同程度的LA结构重构及形态改变，结构重构表现在心房扩大、心房肌超微结构改变以及间质纤维化，形态改变与LA负荷压力过高有关，为保持结构稳定性，LA往往发生球形重构[6-7]，左心房球形度与二尖瓣狭窄患者血栓事件有关[8]，这与LA对称性改变有关，引起血流模式改变、血流淤滞、炎症反应以及血小板激活促进血栓形成[7]。左心房容积指数（Left atrium volume index，LAVI）是反映左心房重构的指标，可能与AF患者的栓塞事件有关。