摘要
目的 调查合并心房血栓的非瓣膜性心房颤动(NVAF)患者的临床特征,并比较既有的心房颤动(房颤)栓塞风险评分系统对优化抗凝后心房血栓不消退的预测价值.方法 本研究为横断面研究.回顾性连续入选2012年1月至2022年7月在南京医科大学第一附属医院心血管内科住院,明确诊断心房血栓并接受影像学复查的NVAF患者.根据复查结果将患者分为血栓消退组和血栓未消退组.用受试者工作特征(ROC)曲线评估既有的房颤栓塞风险评分系统对预测优化抗凝后心房血栓不消退的效能,结果用ROC曲线下面积(AUC)表示.结果 纳入60例患者,年龄(60.7±11.3)岁,其中男41例(68.3％,41/60).52例(86.7％,52/60)患者的心房血栓分布于左心耳.抗凝方案调整后,抗凝药的使用率由基线的78.3％(47/60)提升至100.0％(60/60).复查发现36例(60.0％,36/60)患者的血栓出现了消退.CHADS2评分、改良CHADS2评分、CHA2DS2-VASc评分、CHA2DS2-VAK评分、NICE指南评分和美国心脏病学会/美国心脏协会/欧洲心脏病学会指南评分对于预测优化抗凝后心房血栓不消退的AUC分别为0.720、0.687、0.720、0.728、0.757和0.667.结论 合并心力衰竭、既往脑卒中/短暂性脑缺血发作、血管疾病史及脑钠肽升高,较高CHA2DS2-VASc评分和HAS-BLED评分、较大左心房内径的NVAF患者的心房血栓常难以消退.NICE指南评分系统对NVAF患者心房血栓不消退的预测价值较高,对NICE指南评分定义的高风险患者应强化抗凝.
Abstract
Objective To investigate the clinical characteristics of patients with non-valvular atrial fibrillation(NVAF)and atrial thrombus,and to compare the existing stroke risk stratification schemes of atrial fibrillation in predicting the non-resolution of atrial thrombus after the optimization of anticoagulation strategy.Methods This cross-section study consecutively enrolled patients with NVAF and atrial thrombus who were admitted to the Department of Cardiology,The First Affiliated Hospital of Nanjing Medical University from January 2012 to July 2022 for definite diagnosis of atrial thrombosis and reexamined using imaging test.According to the reexamination results,patients were divided into the resolution group and non-resolution group.The capacity of the existing stroke risk stratification schemes in predicting the non-resolution of atrial thrombus was assessed using areas under the receiver operating characteristic curves(AUC)with 95％CI.Results In total,60 patients were included in the study[mean age(60.7±11.3)years],and 41(68.3％,41/60)were males.Atrial thrombus was in the left atrial appendage in 52(86.7％,52/60)patients.After detection of atrial thrombus,the usage rate of anticoagulants increased from original 78.3％(47/60)to 100.0％(60/60).During follow-up,36(60.0％,36/60)patients showed complete resolution of atrial thrombus.The A UC among CHADS2 score,modified CHADS2 score,CHA2DS2-VASc score,CHA2DS2-VAK score,NICE guidelines score,and American College of Cardiology(ACC)/American Heart Association(AHA)/European Society of Cardiology(ESC)guidelines score for predicting the non-resolution of atrial thrombus were 0.720,0.687,0.720,0.728,0.757 and 0.667,respectively.Conclusion In patients with heart failure,history of stroke/transient ischemic attack,vascular disease,elevated level of brain natriuretic peptide,high CHA2DS2-VASc score and HAS-BLED score,and large left atrial diameter,the atrial thrombus is more difficult to resolve.NICE guidelines score has a high predictive value for the non-resolution of atrial thrombus in patients with NVAF.Anticoagulation should be enhanced in patients at high-risk category defined by NICE guidelines score.
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