在心脏转移之前识别高风险的左心室尾血栓患者:CLOTS-AF得分
Louise Segan1,2,3, Shane Nanayakkara1,2,4, Ella Spear5
1The Alfred Hospital Melbourne Australia.
Journal of the American Heart Association
|June 10, 2023
概括
一个新的CLOTS-AF风险评分识别了心房的患者在心脏转变之前存在左心房尾血栓 (LAAT) 的高风险. 这个分数使用临床和心声回声数据来指导抗凝治疗,提高患者的安全性.
科学领域:
- 心脏病学 心脏病学
- 医疗成像医学成像
- 血栓形成研究研究
背景情况:
- 通过食道心声学 (TEE) 引导的心脏转变推给心房动 (AF) 患者,这些患者有左心房附属体血栓 (LAAT) 的风险.
- 对LAAT的风险因素仍然定义不佳,需要更好的预测工具.
研究的目的:
- 在心脏转变前接受TEE的AF患者中确定LAAT的临床和心声预测因子.
- 开发和验证一种新的风险评分 (CLOTS-AF) 以预测LAAT.
主要方法:
- 在2002年至2022年期间,对1001名患有AF/心房的患者进行了回顾性分析,这些患者接受了TEE.
- 为了确定LAAT预测因素的回归分析,形成CLOTS-AF得分,在70%的队列中开发,在30%的队列中验证.
- 评估临床参数 (肌素,AF持续时间/节律,中风,糖尿病) 和心声回声检测结果 (LVEF,LAVI,TAPSE).
主要成果:
- 在14%的患者中发现了LAAT,在7.5%的患者中发现了密集的自发回声对比,排除了心脏转变.
- CLOTS-AF得分,包括肌素,左心室喷射分数,超负荷,三环状平面缩外流,中风和AF节奏,显示出出色的预测性能 (AUC 0.820).
- 权重的CLOTS-AF得分保持了良好的预测性能 (AUC 0.780) 准确率为72%.
结论:
- 在接受心脏转换的不充分抗凝血AF患者中,LAAT或密集自发回声对比的发生率为21%.
- 临床和心声学参数可以有效地识别LAAT风险增加的患者.
- CLOTS-AF评分有助于选择可能受益于心脏转变前抗凝期的患者.
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