论文部分内容阅读
目的:探讨CHA_2DS_2-VASc评分结合左心房重构指标预测非瓣膜性心房颤动(non-valvular atrial fibrillation,NVAF)患者发生脑卒中风险的价值。方法:共纳入216例符合入组标准的NVAF患者,并且依据病史及辅助检查计每位入选者的CHA_2DS_2-VASc评分,根据评分结果将患者分为高危组及低中危组。同时记录患者超声心动图中左房内径(LAD)及左房容积-时间曲线中左心房最大容积(LAV_(max))。依据随访结果将入选患者分为脑卒中组和非脑卒中组。结果:高危组LAD和LAV_(max)水平均显著高于低中危组(P<0.05)。以随访期内最终发生脑卒中事件为金标准,绘制ROC曲线,得出LAD及LAV_(max)曲线下面积(AUC)分别为0.890和0.891,当LAD≥39.9 mm或LAV_(max)≥40.35 m L时NVAF患者发生脑卒中的风险更高。然后形成CHA_2DS_2-VASc-LAD-LAV_(max)联合评分,经ROC曲线分析得出AUC为0.878,而单纯运用CHA_2DS_2-VASc评分的AUC为0.810。当CHA_2DS_2-VASc-LAD-LAV_(max)评分≥2分时,NVAF患者更易发生脑卒中事件。结论:CHA_2DS_2-VASc评分联合LAD及LAV_(max)对NVAF患者发生脑卒中风险有更高的预测价值。
Objective: To investigate the value of CHA_2DS_2-VASc score combined with left atrial remodeling in predicting stroke risk in patients with non-valvular atrial fibrillation (NVAF). METHODS: A total of 216 eligible patients with NVAF were enrolled in this study. CHA_2DS_2-VASc was scored for each participant according to their medical history and laboratory tests. According to the results, patients were divided into high-risk group and low-risk group. The left atrial appendage (LAD) and left atrium volume-time curve (LAV max) in the echocardiogram were recorded. Patients were divided into stroke group and non-stroke group according to the follow-up results. Results: The levels of LAD and LAV max in high risk group were significantly higher than those in low and medium risk group (P <0.05). Taking the final stroke event during the follow-up period as the gold standard, the ROC curve was plotted, and the area under the LAD and LAV max curves were 0.890 and 0.891, respectively. When LAD≥39.9 mm or LAV max≥40.35 m L patients with NVAF at higher risk of stroke. The combined score of CHA_2DS_2-VASc-LAD-LAV-max was then obtained. The AUC was 0.878 by ROC curve analysis. The AUC of CHA_2DS_2-VASc was 0.810. When the CHA_2DS_2-VASc-LAD-LAV max score was greater than or equal to 2, stroke patients were more likely to develop NVAF. Conclusion: CHA_2DS_2-VASc score combined with LAD and LAV max have a higher predictive value for stroke risk in patients with NVAF.