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Атеротромбоз

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ТРОМБОЗ ЛЕВОГО ПРЕДСЕРДИЯ И/ИЛИ ЕГО УШКА ПРИ НЕКЛАПАННОЙ ФИБРИЛЛЯЦИИ ПРЕДСЕРДИЙ: ЧАСТОТА ВЫЯВЛЕНИЯ И КЛИНИЧЕСКИЕ ФАКТОРЫ РИСКА

https://doi.org/10.21518/2307-1109-2019-2-68-79

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Аннотация

В обзоре представлены данные о частоте выявления тромбоза в левом предсердии (ЛП и/или его ушке (уЛП) у больных с неклапанной фибрилляцией предсердий (нФП), охарактеризована их связь с проводимой антитромботической терапией и наличием сердечно-сосудистых факторов риска. Продемонстрировано, что тромбоз в ЛП/уЛП выявляется в 4–19% случаев. При этом данные о частоте тромба в ЛП/уЛП получены при обследовании небольших когорт пациентов с ФП, подвергнутых чреспищеводной эхокардиография перед катетерной изоляцией устьев легочных вен, кардиоверсией, установкой окклюдеров в уЛП. Информация о частоте тромбоза в ЛП/уЛП вне проведения указанных процедур крайне ограничена.
Частота выявления тромба в ЛП/уЛП варьируется в зависимости контингента изученных, наличия сердечно-сосудистых факторов риска (сахарный диабет, метаболический синдром, артериальная гипертензия, хроническая болезнь почек, хроническая сердечная недостаточность) и особенностей антикоагулянтной терапии. Шкалы CHADS2 и CHA2DS2-VASc недостаточно хорошо предсказывают наличие тромба в ЛП/уЛП. Так, по меньшей мере 50% больных с тромбом ЛП/уЛП могут иметь низкий балл согласно этим шкалам и, соответственно, риск сердечных тромбоэмболий у них будет недооценен. Согласно накопленным фактам адекватная антикоагулянтная терапия не гарантирует отсутствия тромба в ЛП/уЛП. Причем примерно в 40% случаев тромботические образования в ЛП/уЛП не исчезают через 1 год антитромботического лечения.

Об авторах

И. А. Заиграев
Национальный медицинский исследовательский центр профилактической медицины Минздрава России
Россия
аспирант отдела клинической кардиологии и молекулярной генетики

101000, Россия, Москва, Петроверигский пер., д. 10


И. С. Явелов
Национальный медицинский исследовательский центр профилактической медицины Минздрава России
Россия

д.м.н., ведущий научный сотрудник отдела клинической кардиологии и молекулярной генетики

101000, Россия, Москва, Петроверигский пер., д. 10



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Для цитирования:


Заиграев И.А., Явелов И.С. ТРОМБОЗ ЛЕВОГО ПРЕДСЕРДИЯ И/ИЛИ ЕГО УШКА ПРИ НЕКЛАПАННОЙ ФИБРИЛЛЯЦИИ ПРЕДСЕРДИЙ: ЧАСТОТА ВЫЯВЛЕНИЯ И КЛИНИЧЕСКИЕ ФАКТОРЫ РИСКА. Атеротромбоз. 2019;(2):68-79. https://doi.org/10.21518/2307-1109-2019-2-68-79

For citation:


Zaigrayev I.A., Yavelov I.S. THROMBUS OF LEFT ATRIUM AND/OR ITS APPENDAGE IN CASE OF NONVALVULAR ATRIAL FIBRILLATION: FREQUENCY OF DETECTION AND CLINICAL RISK FACTORS. Atherothrombosis. 2019;(2):68-79. (In Russ.) https://doi.org/10.21518/2307-1109-2019-2-68-79

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