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目的探讨经食管超声左心耳(LAA)参数与心房颤动(简称房颤)患者LAA血栓和/或自发显影(SEC)是否存在相关性。方法选取在本院心血管内科收治并接受经食管超声心动图(TEE)检查发现LAA血栓和/或SEC的房颤患者34例为SEC组;同时,同期以1∶2的比例随机选取接受TEE检查但并未发现LAA血栓和/或SEC的房颤患者68例为非SEC组。收集患者既往病史资料,并测定其左房前后径(LAD)、左室射血分数(LVEF)和左心耳开口宽度(LAAW)、左心耳长度(LAAL)、左心耳血流排空速度(LFEV)、左心耳血流充盈速度(LFFV)、左心耳射血分数(LAAEF)等指标。多因素Logistic回归分析房颤患者LAA血栓和/或SEC的独立危险因素。结果两组之间年龄、房颤类型(持续性房颤比例)、脑卒中/短暂脑缺血发作(TIA)病史、CHA_2DS_2-VASc评分、LAD、LAAW、LAAL、LVEF、LFEV、LFFV、LAAEF差异有统计学意义。调整其他危险因素,通过多因素Logistic回归分析发现,既往脑卒中/TIA(OR 22.894;95%CI 1.883~278.418;P=0.014),更大的LAAW(OR 1.205;95%CI 1.008~1.441;P=0.040)、LAAL(OR 1.203;95%CI 1.039~1.394;P=0.014)及更低的LAAEF(OR 0.964;95%CI 0.929~0.999;P=0.047)是房颤患者LAA血栓和/或SEC的独立危险因素。结论房颤患者LAA结构增大及较低的LAAEF提示LAA血栓和/或SEC的可能性增大。
Objective To investigate whether LAA thrombus and / or spontaneous development (SEC) in patients with atrial fibrillation (LAF) and transthoracic echocardiography (LAA) are correlated with each other. Methods 34 patients with atrial fibrillation who were found to have LAA thrombus and / or SEC underwent transesophageal echocardiography (TEE) in our department of cardiovascular medicine were enrolled in the SEC group. At the same time, TEE 68 patients with atrial fibrillation who were examined but did not find LAA thrombus and / or SEC were non-SEC subjects. The patients’ past history data were collected and their left atrium anterior-posterior diameter (LAD), left ventricular ejection fraction (LVEF), left atrial appendage LAAW, LAAL, left atrial appendage velocity (LFEV ), Left atrial appendage flow filling velocity (LFFV), left atrial appendage ejection fraction (LAAEF) and other indicators. Multivariate Logistic regression analysis of independent risk factors for LAA thrombus and / or SEC in patients with AF. Results The differences of age, type of atrial fibrillation (persistent AF), history of stroke / transient ischemic attack (TIA), CHA_2DS_2-VASc score, LAD, LAAW, LALF, LFEV, LFFV and LAAEF There is statistical significance. Other risk factors were adjusted and multivariate Logistic regression analysis showed that the prevalence of previous strokes / TIA (OR 22.894; 95% CI 1.883-278.418; P = 0.014), greater LAAW (OR 1.205; 95% CI 1.008-1.441; P = 0.040), LAA (OR 1.203; 95% CI 1.039-1.394; P = 0.014) and lower LAAEF (OR 0.964; 95% CI 0.929-0.99; P = 0.047) Of independent risk factors. Conclusions Increased LAA structure in patients with atrial fibrillation and lower LAAEF are associated with an increased likelihood of LAA thrombosis and / or SEC.