【摘要】 目的探索非瓣膜性心房颤动(房颤)患者左心房血栓(left atrial thrombus,LAT)和(或)自发超声显影(spontaneous echocardiographic contrast,SEC)临床特征及长期结局。方法 2007年7月至2015年1月期间2 625例行食道超声心动图的非瓣膜性房颤患者,91例有LAT和(或)SEC,收集其临床资料并随访,记录其抗凝依从性、LAT和(或)SEC溶解,卒中、出血、死亡等情况。结果患者初始抗凝率100%,随访(33.7±24.2)个月。服用抗凝药超过1年者60例(65.9%),超过2年者54例(59.3%)。36例患者服用抗凝药后3～6个月复查食道超声心动图,其中24(66.7%)例患者LAT和(或)SEC溶解。3例患者服用华法林期间新发缺血性脑卒中事件6次,均未遗留后遗症。23例患者服用华法林期间出现出血事件:1例为左侧基底节区脑出血;1例为消化性溃疡出血;余为小出血。2例患者死亡,1例死因为左侧基底节区脑出血、脑疝,1例为心源性猝死。结论本研究中,非瓣膜性房颤伴LAT和(或)SEC患者,抗凝治疗率及依从性相对较高,多数LAT和(或)SEC经抗凝治疗可溶解,缺血性卒中风险较低。更多还原

【Abstract】 Objectives To investigate the clinical features and long-term outcomes of non-valvular atrial fibrillation(NVAF)patients with left atrial thrombus(LAT)and(or)spontaneous echocardiographic contrast(SEC).Methods We performed transesophageal echocardiograms(TEE)in 2,625 NVAF patients from July 2007 to January 2015,and91 patients were found to have LAT and(or)SEC. Data on patients` characteristics,echocardiographic findings,outcome such as anticoagulant compliance,LAT and(or)SEC dissolution,stroke,bleeding and death were recorded.ResultsOral anticoagulation was initiated in all patients. During a follow-up of(33.7±24.2)months,65.9% patientscontinued anticoagulation therapy within 1 year,and 59.3% within 2 years. On the follow-up TEE study in 36 patients,LAT and(or)SEC resolved in 24(66.7%)patients after taking anticoagulant therapy for 3-6 months. Three patientssuffered a total of 6 ischemic strokes while taking warfarin and all recovered without obvious neurologic sequelae.Twenty-three patients had bleeding events,1 had left basal ganglia hemorrhage,hernia and subsequent dead;1 hadpeptic ulcer bleeding,21 had minor bleeding events. Two patients had died,one due to cerebral hernia caused by leftbasal ganglia cerebral hemorrhage,the other due to sudden cardiac death.ConclusionsIn our study,NVAF patients with LAT and(or)SEC have relatively higher anticoagulant rates and compliance. Most LAT and(or)SEC resolveafter anticoagulant therapy. Such patients had a lower risk of ischemic stroke when taking anticoagulant therapy.更多还原