[Clinical characteristics of left atrial appendage thrombus in patients with hypertrophic cardiomyopathy and non-valvular atrial fibrillation].

Objective: To investigate the incidence and clinical characteristics of left atrial appendage (LAA) thrombus in patients with hypertrophic cardiomyopathy (HCM) and non-valvular atrial fibrillation (AF) . Methods: Data from 10 440 patients with AF who had undergone transesophageal echocardiography (TEE) before cardioversion or catheter ablation at Beijing Anzhen Hospital from April 2006 to December 2018 were retrospectively screened. Two hundred and five HCM patients were included, 820 AF patients with the same CHA(2)DS(2)-VASc score over the same period were selected as the control group. HCM patients were divided into two subgroups based on presence or absence of LAA thrombus/sludge. The baseline of clinical information, transthoracic echocardiographic and TEE measures were compared among all the groups. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of left atrial diameter (LAD) for LAA thrombus/sludge. Multivariate logistic regression analysis was applied to analyze the correlative factors of LAA thrombus/sludge in HCM patients. Results: The incidences of LAA thrombus or sludge were higher in HCM group than in control group (10.7% (22/205) vs. 0.7% (6/820); 8.8% (18/205) vs.7.0% (57/820), P<0.001) . In HCM patients, LAD was significantly larger in LAA thrombus/sludge subjects than in those without thrombus/sludge ((48.9±5.1)mm vs. (45.2±6.1) mm, P<0.001). CHA(2)DS(2)-VASc score was similar between the two subgroups ((2.0±1.4) vs. (1.8±1.4), P>0.05). There was no difference in the rate of patients with a CHA(2)DS(2)-VASc scores ≥2 between the subgroups(62.5% (25/40) vs. 57.0% (94/165), P=0.525). The incidences of LAA thrombus in HCM and AF patients with CHA(2)DS(2)-VASc scores of 0, 1 and 2 were 8.8% (3/34) , 9.6% (5/52) , 11.8% (11/119) , respectively; and the rate of LAA sludge were 8.8% (3/52) , 7.7% (4/52) , 9.2% (11/119) , respectively. The cut off value of LAD for the diagnosis of LAA thrombus/sludge was 44.5 mm. Multivariate logistic regression analysis showed that LAD≥44.5 mm (OR=5.134, 95%CI 1.862-14.156, P=0.002) , non-paroxysmal AF (OR=2.782, 95%CI 1.238-6.252, P=0.013) , previous thromboembolism or stroke (OR=1.820, 95%CI 0.774-4.227, P=0.017) were independent determinants of LAA thrombus/sludge. Conclusions: The incidence of LAA thrombus/sludge is higher in patients with HCM and AF than in AF patients without HCM. The CHA(2)DS(2)-VASc score is similar between HCM and AF patients with LAA thrombus/sludge and those without thrombus/sludge. Patients with CHA(2)DS(2)-VASc score 0-1 are also likely to suffer LAA thrombus/sludge. Left atrial enlargement is associated with LAA thrombus/sludge.目的： 观察肥厚型心肌病（HCM）非瓣膜性心房颤动（房颤）患者的左心耳（LAA）血栓发生率及其临床特征。 方法： 回顾性连续筛查于2006年4月1日至2018年12月1日在北京安贞医院因房颤行心脏电复律或导管消融术，术前经食管超声心动图检查（TEE）的10 440例患者，其中205例诊断为HCM，作为HCM组。按1∶4比例入选同一时期经CHA(2)DS(2)-VASc评分匹配的无HCM患者820例为对照组。其中又根据TEE结果将HCM患者分为LAA血栓/淤泥亚组和无血栓/淤泥亚组。收集入选患者的临床资料及经胸超声心动图和TEE检查结果。比较各组的基线资料及LAA血栓/淤泥发生率，绘制受试者工作特征（ROC）曲线评估左心房前后径（LAD）诊断LAA血栓/淤泥的最佳界值；采用多因素logistic回归分析HCM房颤患者发生LAA血栓/淤泥的相关因素。 结果： HCM房颤患者的LAA血栓和淤泥检出率均高于对照组[10.7%（22/205）比0.7%（6/820）；8.8%（18/205）比7.0%（57/820），P均<0.001]。在HCM房颤患者中，LAA血栓/淤泥亚组的LAD大于无LAA血栓/淤泥亚组[（48.9±5.1）mm比（45.2±6.1）mm，P<0.001]；两组间的CHA(2)DS(2)-VASc评分[（2.0±1.4）比（1.8±1.4），P>0.05]以及CHA(2)DS(2)-VASc评分≥2分患者的比例[62.5%（25/40）比57.0%（94/165），P=0.525]比较，差异无统计学意义。CHA(2)DS(2)-VASc评分0、1和≥2分的LAA血栓率分别为8.8%（3/34）、9.6%（5/52）和11.8%（11/119）；LAA淤泥率分别为8.8%（3/52）、7.7%（4/52）和9.2%（11/119）。ROC曲线显示LAD 44.5 mm为诊断LAA血栓/淤泥的最佳截点，其敏感度为87.5%，特异度为49.7%。多因素logistic回归分析显示，LAD≥44.5 mm（OR=5.134，95%CI 1.862~14.156，P=0.002）、非阵发性房颤（OR=2.782，95%CI 1.238~6.252，P=0.013）和卒中/血栓栓塞（OR=1.820，95%CI 0.774~4.227，P=0.017）与HCM房颤患者的LAA血栓/淤泥独立相关。 结论： HCM房颤患者的LAA血栓/淤泥发生率高于无HCM房颤患者。HCM房颤是否合并LAA血栓/淤泥患者的CHA(2)DS(2)-VASc评分无明显差异，0~1分的患者仍可发生LAA血栓/淤泥。LAA血栓/淤泥患者的左心房更大。.