上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2022, Vol. 42 ›› Issue (3): 344-349.doi: 10.3969/j.issn.1674-8115.2022.03.012

• 论著 · 临床研究 • 上一篇    下一篇

心房颤动左心耳封堵前后左心房自发显影临床分析

赵志宏(), 王赛华, 郝淑雯, 宋湘, 罗俊, 武英彪, 朱茜, 方明, 田蓓, 顾薇, 宁忠平()   

  1. 上海健康医学院附属周浦医院心内科，上海 201318
  • 收稿日期:2021-09-03 出版日期:2022-03-28 发布日期:2022-05-09
  • 通讯作者: 宁忠平 E-mail:zhihong_zhao@pku.org.cn;ningzhongping88@163.com
  • 作者简介:赵志宏（1972—），男，主任医师，博士；电子信箱：zhihong_zhao@pku.org.cn。
  • 基金资助:
    上海市浦东新区临床医学高峰学科基金(PWYgf2021-04);上海市医学重点专科建设基金(ZK2019B25);上海市浦东新区科技发展基金事业单位民生科研专项基金(PKJ2021-Y33);上海市浦东新区卫生健康委员会重点亚专科建设基金(PWZy2020-08)

Clinical analysis of left atrial spontaneous echo contrast before and after left atrial appendage closure in patients with atrial fibrillation

ZHAO Zhihong(), WANG Saihua, HAO Shuwen, SONG Xiang, LUO Jun, WU Yingbiao, ZHU Qian, FANG Ming, TIAN Bei, GU Wei, NING Zhongping()   

  1. Department of Cardiology, Shanghai Pudong New Area Zhoupu Hospital, Shanghai University of Medicine & Health Sciences, Shanghai 201318, China
  • Received:2021-09-03 Online:2022-03-28 Published:2022-05-09
  • Contact: NING Zhongping E-mail:zhihong_zhao@pku.org.cn;ningzhongping88@163.com
  • Supported by:
    Shanghai Pudong Top Level Clinical Discipline Fund(PWYgf2021-04);Shanghai Key Medical Specialty Program Construction Fund(ZK2019B25);Shanghai Pudong Science and Technology Development Fund(PKJ2021-y33);Shanghai Pudong Health Committee Key Sub-Specialized Construction Fund(PWZy2020-08)

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摘要：

目的·分析心房颤动（房颤）患者行左心耳封堵（left atrial appendage closure，LAAC）前后左心房自发显影（left atrial spontaneous echo contrast，LA SEC）发生情况及其与装置相关血栓（device-related thrombus，DRT）发生的关系，和对临床预后的影响。方法·该研究为回顾性、横断面研究，连续入选2018年8月至2020年12月在上海健康医学院附属周浦医院心内科用LAmbre封堵器行LAAC并完成术前及术后经食管超声心动图（transesophageal echocardiography，TEE）检查的非瓣膜性房颤患者126例，LAAC术前LA SEC患者比例为19.8%（25/126）。根据术前TEE结果分为LA SEC组（n=25）和无LA SEC组（n=101），分析患者基线资料、LAAC相关资料、围手术期并发症；术后TEE复查时间中位数为72 d，根据TEE结果，再次分为LA SEC组（n=58）和无LA SEC组（n=68）进行分析。对这些患者平均随访（12±6）个月，比较DRT发生情况，随访缺血性脑卒中及脑出血事件发生情况。结果·房颤患者LAAC术前LA SEC患者较无LA SEC患者接受抗凝方案的比例偏低，左心房内径及左心室内径增大，射血分数降低。LAAC后TEE复查诊断的LA SEC病例数增加至46.0%（58/126），其中40.0%（10/25）的LAAC前LA SEC患者封堵后TEE复查LA SEC继续存在；新发生LA SEC患者48例，占总例数的38.1%（48/126）。LAAC术后，TEE复查明确的LA SEC患者左心耳口直径较大及LAAC术后未接受抗凝方案而是选择抗血小板方案；LA SEC患者及无LA SEC患者之间死亡事件、缺血性脑卒中/短暂性缺血发作、脑出血事件发生率差异无统计学意义（均P>0.05）。结论·房颤患者行LAAC术前TEE诊断的LA SEC患者特点为抗凝比例偏低，左心房及左心室增大，射血分数降低；LAmbre封堵术后TEE复查诊断的LA SEC患者特点为左心耳口直径更大，术后抗凝比例偏低，但临床预后与无LA SEC患者无明显差异。

关键词: 心房颤动, 左心耳封堵术, 左心房自发显影, 装置相关血栓

Abstract:

Objective·To investigate the occurrence of left atrial spontaneous echo contrast (LA SEC) both before and after left atrial appendage closure (LAAC) in the atrial fibrillation (AF) patients, and its relationship with device-related thrombus (DRT) and clinical prognosis.

Methods·This study was a retrospective, cross-sectional study. A total of 126 nonvalvular AF patients receiving LAAC with LAmbre and completing transesophageal echocardiography (TEE) review were enrolled from August 2018 to December 2020 in Shanghai Pudong New Area Zhoupu Hospital, Shanghai University of Medicine & Health Sciences. The proportion of AF patients with LA SEC was 19.8% (25/126) before LAAC. The AF patients were divided into LA SEC group (n=25) and non-LA SEC group (n=101), and the clinical data, LAAC-related data, and perioperative complications were analyzed. TEE review time median was 72 d after LAAC. The patients were redivided into LA SEC group (n=58) and non-LA SEC group (n=68) for analysis. The average follow-up was (12±6) months. The incidence of DRT was compared, and the incidences of ischemic stroke and cerebral hemorrhage events were followed up.

Results·Before LAAC, the proportion of oral anticoagulation was low, the left atrium diameter and the left ventricle diameter increased, and the left ventricle ejection fraction decreased in the LA SEC group. The incidence of LA SEC after LAAC reviewed by TEE increased to 46.0%, including 38.1% (48/126) new occurred LA SEC patients, and 40.0% (10/25) LA SEC patients with LA SEC. The redivided LA SEC group had longer left atrial appendage orifice diameter and lower application rate of anticoagulant treatment regimen. There was no significant difference in the incidence of death, ischemic stroke/transient ischemic attack, and cerebral hemorrhage between the two groups (all P>0.05).

Conclusion·The AF patients undergoing LAAC with LA SEC before operation are characterized by low anticoagulation ratio, left atrium and left ventricle enlargement, and decreased left ventricle ejection fraction. After LAAC with LAmbre, the LA SEC patients diagnosed by TEE review have longer left atrial appendage ostium diameter and lower anticoagulant treatment regimen ratio. LA SEC does not affect the clinical prognosis.

Key words: atrial fibrillation, left atrial appendage closure (LAAC), left atrial spontaneous echo contrast (LA SEC), device-related thrombus (DRT)

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