Activated protein C resistance (APC-R) is the most common inherited cause of clinically apparent venous thromboembolism. Previous data indicate that left atrial thrombus (LAT) formation is a common complication in mitral stenosis (MS) and a hypercoagulable state exists in these patients. The aim of this study was to invastigate the association between APC-R and LAT formation in patients with MS. Seventy-seven consecutive patients with rheumatic MS were included in this study. Transesophageal echocardiography was performed on all patients to assess the presence of any thrombus or spontaneous echo contrast (LASEC) in the left atrial cavity or appendage. Thirty four of the patients had LAT and 43 did not. Prevelance of APC-R was smiliar between the two groups of patients with and without LAT (23% vs 16%, p=0.425). LAT(+) patients had higher incidence of atrial fibrillation (AF, 74% vs 51%, p=0.046) and LASEC (71% vs 19%, p<0.001) compared to LAT(-) patients. On multivariate regression analysis, only the presence of LASEC achieved statistical significance as an independent risk factor for LAT formation (p=0.0001, odds ratio=9.589, 95% confidence interval [CI] =3.143-29.251). Because on (continued on next page) univariate analysis both LASEC and AF were associated with LAT, we also compared the prevelance of APC-R in the subgroups of patients who have these risk factors with and without LAT. There was a correlation between the presence of APC-R and LAT in the AF(+) subgroup of MS patients (p=0.033, odds ratio=8.167, 95% CI=1.001-72.812). However, the presence of APC-R was not associated with the increased risk of LAT in LASEC(+) patients (p=0.217, odds ratio =1.200, 95% CI=1.003-1.435). Although the presence of APC-R itself is not an independent risk factor for LAT formation in MS, it may increase the risk of LAT when present in combination with AF (as an additional risk factor) in these patients.
激活蛋白C抵抗(APC-R)是临床明显的静脉血栓栓塞最常见的遗传性原因。先前的数据表明,左心房血栓(LAT)形成是二尖瓣狭窄(MS)的常见并发症,并且这些患者存在高凝状态。本研究旨在调查APC-R与MS患者中LAT形成之间的关联。本研究纳入了77例风湿性MS连续患者。对所有患者进行食管超声心动图检查,评估左心房腔或心耳中是否存在任何血栓或自发性回声对比(LASEC)。其中34例患者有LAT,43例没有。两组患者中APC-R的患病率相似(23% vs 16%,p=0.425)。LAT(+)患者与LAT(-)患者相比,房颤(AF)发生率更高(74% vs 51%,p=0.046),LASEC发生率更高(71% vs 19%,p<0.001)。多元回归分析显示,只有LASEC的存在在LAT形成中达到统计学意义上的独立风险因素(p=0.0001,比值比=9.589,95%置信区间[CI]=3.143-29.251)。因为在单变量分析中,LASEC和AF都与LAT相关,我们还比较了这些风险因素存在与不存在的子组中APC-R的患病率。在MS患者的AF(+)亚组中,APC-R的存在与LAT之间存在相关性(p=0.033,比值比=8.167,95% CI=1.001-72.812)。然而,在LASEC(+)患者中,APC-R的存在与LAT增加风险无关(p=0.217,比值比=1.200,95% CI=1.003-1.435)。尽管APC-R的存在本身不是MS中LAT形成的独立风险因素,但当与AF(作为额外风险因素)结合存在时,可能会增加这些患者LAT的风险。