心房颤动患者左心耳自发性回声造影与血栓栓塞事件和死亡率增高有关。

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-02-01 DOI:10.1016/j.ijcha.2024.101590

Jan Traub , David Hettesheimer , Jule Pinter , Floran Sahiti , Georg Fette , Carsten Henneges , Caroline Morbach , Sebastian Herrmann , Frank Puppe , Anna Frey , Stefan Störk , Martin Christa

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引用次数: 0

摘要

背景：心律转复是心房颤动（AF）的一种心律控制治疗方法，需要排除心脏栓塞源，通常起源于左心房附件（LAA）。经食管超声心动图（TEE）用于LAA评估，但它是有创的，并没有广泛使用。本研究旨在确定与LAA异常相关的心血管危险因素以及血栓栓塞事件和全因死亡率的预测因素。方法：采用单中心回顾性分析，纳入2009年至2018年在德国 rzburg大学医院接受TEE治疗的房颤患者。结果：2400例房颤患者(中位年龄72岁；36%的女性)，469例（20%）有LAA异常，282例（60%）有自发性回声造影剂（SEC）， 72例（15%）有血栓形成（THR）， 115例（25%）两者都有。LAA异常的预测因素包括年龄(OR 1.04；p = 0.002)，充血性心力衰竭(OR 1.70；p = 0.009)，糖尿病(OR 1.74；p = 0.007)、卒中史(OR 3.36；p = 0.001)，血管疾病(OR 1.57；p = 0.026)，碱性磷酸酶升高(OR 1.15；p = 0.003)，先前的VKA摄入量(OR 1.53；p = 0.002)， DOAC摄入量(OR 0.57；p = 0.038)。经心血管危险因素、抗凝和实验室数据校正后，伴有或不伴有THR的SEC可独立预测血栓栓塞事件（HR 1.74, p = 0.031和HR 1.53, p = 0.006）和全因死亡率（HR 1.77, p = 0.011和HR 1.57, p = 0.002）。结论：在接受TEE治疗的房颤患者中，在转复决策中经常被忽视的SEC可以独立预测血栓栓塞事件和死亡率。

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Spontaneous echo contrast in the left atrial appendage is linked to a higher risk of thromboembolic events and mortality in patients with atrial fibrillation

Background

Cardioversion, a rhythm control treatment for atrial fibrillation (AF), requires ruling out cardiac embolic sources, often originating from the left atrial appendage (LAA). Transesophageal echocardiography (TEE) is used for LAA evaluation, but it is invasive and not widely available. This study aimed to identify cardiovascular risk factors linked to LAA abnormalities and predictors of thromboembolic events and all-cause mortality.

Methods

A single-center retrospective analysis included AF patients admitted to the University Hospital Würzburg between 2009 and 2018 undergoing TEE.

Results

Among 2400 AF patients (median age 72; 36 % women), 469 (20 %) had LAA abnormalities: 282 (60 %) had spontaneous echo contrast (SEC), 72 (15 %) had thrombus formation (THR), and 115 (25 %) had both. Predictors of LAA abnormalities included age (OR 1.04; p = 0.002), congestive heart failure (OR 1.70; p = 0.009), diabetes (OR 1.74; p = 0.007), stroke history (OR 3.36; p = 0.001), vascular disease (OR 1.57; p = 0.026), elevated alkaline phosphatase (OR 1.15; p = 0.003), prior VKA intake (OR 1.53; p = 0.002), and DOAC intake (OR 0.57; p = 0.038). SEC with or without THR independently predicted thromboembolic events (HR 1.74, p = 0.031 and HR 1.53, p = 0.006) and all-cause mortality (HR 1.77, p = 0.011 and HR 1.57, p = 0.002), adjusted for cardiovascular risk factors, anticoagulation, and laboratory data.

Conclusions

In AF patients undergoing TEE, SEC, often overlooked in cardioversion decisions, independently predicted thromboembolic events and mortality.

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.