Objective To investigate the relationships between the structure ,function of left atrial as well as cardiac biomarkers and left atrial spontaneous echo contrast ( SEC ) in patients with non‐valvular atrial fibrillation ( NVAF ) ,and evaluate its predictive value for left atrial SEC . Methods T hirty‐four control subjects and 80 patients with NVAF were included ,patients with NVAF were divided into positive group ( 30 cases) and negative group ( 50 cases) according to w hether SEC was presented on transesophageal echocardiography ( T EE ) . Clinical and laboratory data were collected ,including medical history ,cardiac troponin I ( cT nI) ,and pro‐brain natriuretic peptide ( pro‐BNP ) ,etc . T hen CHA2 DS2‐VASc scores were calculated .The left atrial appendage width ( W LAA ) ,left atrial appendage depth ( DLAA ) ,left atrial appendage blood flow velocity ( V LAA ) ,left atrial volume index ( LAVI) and other parameters were measured by T EE and transthoracic echocardiography ( T T E) ,and left atrial ejection fraction ( LAEF ) was calculated . T he clinical and T EE parameters were compared between the positive and negative group ,T T E parameters and cardiac biomarkers levels were compared among the three groups ,and ROC curve was used to evaluate the diagnostic efficiency . Results ①Compared with those in control group ,the value of LAVI and pro‐BNP were significantly increased and LAEF was significantly decreased in negative group ( all P ＜ 0 .01 ) . ②Compared with those in negative group ,CHA 2 DS2‐VASc scores ,WLAA ,DLAA ,LAVI and pro‐BNP levels in positive group showed a significant increase ( all P ＜0 .01) ,LAEF and VLAA showed a significant reduction ( all P ＜0 .01) . ③cT nI between negative group and control group did not show statisticant difference ( P＞0 .05) ,but presented a significant increase in positive group compared with those in control group and negative group (all P ＜0 .01).T he AUC ,sensitivity and specificity of CHA 2 DS2‐VASc scores for SEC were 0 .71 (95% CI :0 .60 ～ 0 .82 ) ,73 .3% and 62 .0%,respectively .When left atrial structural and functional parameters (LAVI and LAEF ) combined with cardiac biomarkers (cT nI and pro‐BNP ) ,the AUC , sensitivity and specificity for SEC were 0 .90 (95% CI :0 .84 ～ 0 .97 ) ,74 .0% and 100%,respectively ,both enhanced w hen compared with CHA 2 DS2‐VASc scores alone ( P ＜ 0 .01 ).Conclusions Left atrial enlargement ,decreased function and elevated levels of cardiac biomarkers are associated with left atrial SEC in patients with NVAF .CHA2 DS2‐VASc scores can be used for perdicting left atrial SEC ,left atrial structural and functional parameters (LAVI and LAEF) combined with cardiac biomarkers (cT nI and pro‐BNP) provide significant increments in prediction of left atrial SEC .%目的 探讨非瓣膜性心房颤动(NVAF)患者左房结构功能参数及心脏生物学标记物与左房自发显影(SEC)的关系,评价其对左房SEC的预测价值.方法 选取NVAF患者80例,据经食管超声心动图(TEE)检查分为SEC阳性组30例、 SEC阴性组50例;同时选取对照组34例.收集临床病史、肌钙蛋白Ⅰ(cT nI) 、脑钠肽前体(pro‐BNP)等,计算CHA2 DS2‐VASc评分; T EE及经胸超声心动图(T T E)检查分别测量左心耳宽度(WLAA ) 、左心耳深度(DLAA ) 、左心耳排空速度(VLAA )及左房容积指数(LAVI)等,计算左房射血分数(LAEF) ;比较SEC阳性组与阴性组临床资料及TEE参数,比较三组患者T T E参数及心脏生物学标记物水平,并绘制ROC曲线评价诊断效能.结果 ①与对照组比较, SEC阴性组LAVI及pro‐BNP均升高( P ＜0 .01) , LAEF降低( P ＜0 .01) .②与SEC阴性组比较, SEC阳性组CHA2 DS2‐VASc评分、 WLAA 、 DLAA 、 LAVI及 pro‐BNP均升高( P ＜ 0 .01) , VLAA及LAEF均降低( P ＜ 0 .01 ) .③ cTnI在 SEC 阴性组与对照组之间差异无统计学意义( P ＞0 .05) ,但SEC阳性组cT nI较对照组及阴性组均升高( P ＜0 .01) . CHA2 DS2‐VASc评分预测左房SEC的ROC曲线下面积(AUC)为0 .71 (95% CI : 0 .60～0 .82) ,敏感性为 73 .3%,特异性为 62 .0%;然而左房结构功能参数(LAVI+ LAEF )联合心脏生物学标记物(cT nI+ pro‐BNP)预测左房 SEC 的AUC (0 .90 , 95% CI : 0 .84～ 0 .97 ) 、敏感性(74 .0%) 、特异性(100%)均有所提高( P ＜ 0 .01 ) .结论 在NVAF患者中,左房增大、左房功能降低及心脏生物学标记物水平升高与左房SEC形成有关.CHA2 DS2‐VASc评分可用于左房SEC的预测,左房结构功能参数(LAVI+ LAEF)联合心脏生物学标记物(cTnI+pro‐BNP)较大地提高了对左房SEC的预测能力.
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