| 摘要: |
| 目的 评估CHADS2、CHA2DS2-VASc和自行改良的CHA2DS2-VASc-LA2评分对经食管超声（TEE）检出左心房或左心耳血栓（LAT）的预测价值。 方法 纳入2007年6月至2012年6月在我科拟行射频消融术且术前TEE检查、心脏多层CT扫描等相关临床资料完整的非瓣膜性心房颤动（NVAF）患者，共203例，其中TEE提示LAT者39例（血栓组），未检出LAT者164例（对照组）。对患者的一般情况、既往病史、入院时检查、CHADS2评分和CHA2DS2-VASc评分进行单因素分析和多因素logistic回归分析，根据logistic回归分析结果，将独立预测因素左心房容积指数（LAVI）≥32 mL/m2记为2分，加入CHA2DS2-VASc评分中组合成新的评分方案CHA2DS2-VASc-LA2。绘制受试者工作特征曲线（ROC），比较CHADS2、CHA2DS2-VASc和CHA2DS2-VASc-LA2评分方案对NVAF患者LAT形成的预测价值。 结果 对CHADS2、CHA2DS2-VASc及CHA2DS2-VASc-LA2三种评分进行ROC曲线检测，发现CHADS2诊断价值偏低（AUC=0.661，P=0.002），CHA2DS2-VASc和CHA2DS2-VASc-LA2诊断价值中等（AUC=0.731，P<0.001；AUC=0.771，P<0.001）。使用CHA2DS2-VASc-LA2评分后血栓组CHADS2评分为0分的3例低危患者分值均有上升，血栓组中无CHA2DS2-VASc-LA2评分为0分者。 结论 CHA2DS2-VASc-LA2评分较CHADS2、CHA2DS2-VASc评分系统能更好地预测NVAF低危人群的LAT形成，CHA2DS2-VASc-LA2评分为0分者可避免常规的TEE检查。 |
| 关键词: 心房颤动 左心房血栓 经食管超声心动描记术 CHADS2评分 CHA2DS2-VASc评分 CHA2DS2-VASc-LA2评分 |
| DOI：10.3724/SP.J.1008.2014.00644 |
| 投稿时间：2013-10-01修订日期：2014-01-02 |
| 基金项目: |
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| Values of three scoring systems in predicting left atrial thrombus in patients with non-valvular atrial fibrillation |
| TAO Xiao-ling,ZHANG Xian-rui,XIONG Bin,YIN Yue-hui,SU Li* |
(Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
*Corresponding authors.) |
| Abstract: |
| Objective To evaluate the values of CHADS2 score, CHA2DS2-VASc score, and self-modified CHA2DS2-VASc-LA2 score in predicting left atrial thrombus (LAT) in patients with non-valvular atrial fibrillation (NVAF). Methods A total of 203 NVAF patients who underwent transesophageal echocardiography (TEE) examination and cardiac multislice CT scans before AF radiofrequency ablation in our department from June 2007 to June 2012 were included in this study. LAT was detected by TEE in 39 patients (thrombosis group) and not detected in 164 patients (control group). The patients' general condition, medical history, admission examination, CHADS2 score and CHA2DS2-VASc score were subjected to univariate analysis and multivariate logistic regression analysis. Then a new CHA2DS2-VASc-LA2 scoring system was formed by combining left atrial volume index (LAVI), recording LAVI ≥32 mL/m2 as 2 points and CHA2DS2-VASc score, which was based on the results of logistic regression analysis. The receiver operating characteristic curve (ROC) was used to compare the values of CHADS2, CHA2DS2-VASc and CHA2DS2-VASc-LA2 scores for predicting LAT formation in NVAF patients. Results ROC curve analysis showed that CHADS2 score had a low predictive value (AUC [area under the curve]=0.661, P=0.002); CHA2DS2-VASc score (AUC=0.731, P<0.001) and CHA2DS2-VASc-LA2 score (AUC=0.771, P<0.001) had middle predictive values. The CHA2DS2-VASc-LA2 scores of the three patients with CHADS2 score being 0 in thrombosis group was increased, and there was no patient in the thrombosis group with CHA2DS2-VASc-LA2 score being 0. Conclusion Compared with CHADS2 and CHA2DS2-VASc systems, CHA2DS2-VASc-LA2 score has a better performance in predicting LAT in low-risk patients with NVAF. It is also suggested that pre-ablation TEE may be unnecessary if the CHA2DS2-VASc-LA2 score is 0. |
| Key words: atrial fibrillation left atrial thrombus transesophageal echocardiography CHADS2 score CHA2DS2-VASc score CHA2DS2-VASc-LA2 score |
