目的 探讨不同评分系统在预测非瓣膜性心房颤动(NVAF)患者左心耳血栓状态(LAATM)上的差异.方法 选取2015年1月1日至2020年12月31日在该院住院并完成经食管超声心动图(TEE)的NVAF患者为研究对象,根据TEE结果将其分为LAATM组和非LAATM组.收集患者的一般资料(包括性别、年龄、合并疾病等),所有患者均采用CHA2DS2-VASc评分、CHA2DS2-VASc-RAF评分、CHA2DS2-VASc-60评分及ABC卒中评分进行评价,分析不同评分系统对LAATM的预测价值.结果 共纳入1217例NVAF患者,其中男647例、女570例.持续性心房颤动529例,阵发性心房颤动688例.TEE示LAATM患者112例,非LAATM患者1 105例.LAATM组患者年龄,持续性心房颤动、吸烟、糖尿病、冠心病、卒中/短暂性脑缺血发作(TIA)、他汀发生率,N末端B型利钠肽原(NT-proBNP)、估算肾小球滤过率(eGFR)等均高于非LAATM组,差异有统计学意义(P＜0.05).4种评分系统中,高危评分人群的LATTM检出率均为最高.ABC卒中评分受试者工作特征(ROC)曲线下面积(0.826)高于其他3种评分(0.741、0.688、0.658),差异有统计学意义(P＜0.05).在持续性心房颤动患者中,ABC卒中评分的ROC曲线下面积(0.836)高于其他3种评分(0.793、0.763、0.724),差异有统计学意义(P＜0.05);在阵发性心房颤动患者中,ABC卒中评分ROC曲线下面积(0.764)高于其他3种评分(0.742、0.686、0.635),差异有统计学意义(P＜0.05).结论 CHA2DS2-VASc评分、CHA2DS2-VASc-RAF评分、CHA2DS2-VASc-60评分及ABC卒中评分均对LAATM 有一定的预测价值,其中ABC卒中评分的预测价值高于其他3种评分.
Objective To investigate the differences in different scoring systems in predicting left atrial appendage thrombotic status(LAATM)in the patients with nonvalvular atrial fibrillation(NVAF).Methods The NVAF inpatients with transesophageal echocardiography(TEE)treated in this hospital from January 1,2015 to December 31,2020 were selected as the study subjects and divided into the LAATM group and non-LAATM group according to the TEE results.The general data of the patients were collected,inclu-ding the sex,age,complicating disease,etc.All patients conducted the scoring by the CHA2DS2-VASc score,CHA2DS2-VASc-RAF score,CHA2DS2-VASc-60 score and ABC stroke score.The predictive value of different scoring systems on LAATM was analyzed.Results A total of 1 217 patients with NVAF were enrolled in this study,including 647 males and 570 females.There were 529 cases of persistent atrial fibrillation,688 cases of paroxysmal atrial fibrillation,TEE showed 112 cases of LAATM and 1 105 cases of non-LAATM.The age,in-cidence of persistent atrial fibrillation,incidence of smoking,incidence of diabetes,incidence of coronary heart disease,incidence of stroke/TIA,incidence of statin,N terminal pro-B type natriuretic peptide(NT-proBNP)and estimated glomerular filtration rate(eGFR)in the LAATM group were higher than those in the non-LAATM group,and the differences were statistically significant(P＜0.05).In 4 kinds of scoring systems,the LATTM detection rate in the population with high risk scores was the highest.The area under the ROC curve of the ABC stroke score(0.826)was higher than that in the other scores(0.741,0.688,0.658),and the differences were statistically significant(P＜0.05).In the patients with persistent atrial fibrillation,the area under the ROC curve of ABC stroke score(0.836)was higher than that of the other three scores(0.793,0.763,0.724,P＜0.05),and in the patients with paroxysmal atrial fibrillation,the area under the ROC curve of ABC stroke score(0.764)was higher than that of the other three scores(0.742,0.686,0.635),and the differences were statistically significant(P＜0.05).Conclusion CHA2DS2-VASc score,CHA2DS2-VASc-RAF score,CHA2 DS2-VASc-60 score and ABC stroke score all have certain predictive value for LAATM,in which the predictive value of ABC stroke score is higher than that of the other three scores.
宋玲;李华康;王斌斌;刘力萍;颜文;陈彦秀;许祥;万陈;刘锋;宋治远
陆军军医大学第一附属医院心血管内科,重庆 400038
临床医学
心房颤动;左心耳血栓;受试者工作特征;ABC卒中评分
atrial fibrillation;left atrial appendage thrombosis;subject operating characteristics;ABC stroke score
《重庆医学》 2024 (007)
985-992 / 8
10.3969/j.issn.1671-8348.2024.07.005
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