心房颤动患者左心耳形态和功能与首发缺血性脑卒中严重程度的相关性分析  

The relationship between left atrial appendage morphology and function and the severity of first ischemic stroke in patients with atrial fibrillation

作　　者：陆曹杰 沈才杰[2] 张丹 刘立志 姜成 邬武斌 LU Caojie;SHEN Caijie;ZHANG Dan(Department of Cardiology,People's Hospital of Fenghua District of Ningbo,Ningbo 315000,China)

机构地区：[1]宁波市奉化区人民医院心内科,315500 [2]宁波市第一医院心内科

出　　处：《心电与循环》2020年第2期142-147,共6页Journal of Electrocardiology and Circulation

基　　金：浙江省医药卫生科研项目(2019KY642)。

摘　　要：目的探讨非瓣膜病心房颤动患者左心耳形态和功能与首发缺血性脑卒中(FEIS)严重程度的关系。方法136例首发缺血性脑卒中心房颤动患者,按照美国国立卫生研究院健康卒中评分将患者分为轻型FEIS组(60例)和中重型FEIS组(76例),经食管超声心动图测定左心耳形态、最大口径(LAA-MD)、容积(LAAV)、峰值血流排空速度(LAA-PEV)、左心耳血栓及自发显影,经胸超声心动图测定左心房内径(LAD)。结果仙人掌型左心耳多见于中重型FEIS组(P<0.05),鸡翅型左心耳多见于轻型FEIS组(P<0.05)。中重型FEIS组LAD、CHA2DS2-VASc评分、持续性心房颤动与入院心房颤动节律比例高于轻型FEIS组(均P<0.05),而LAA-PEV低于轻型FEIS组(P<0.05)。多因素logistic回归分析显示:仙人掌型左心耳和LAD是心房颤动患者发生中重度缺血性脑中风的独立危险因素(OR=3.17、1.34,95%CI:1.67~8.75、1.74~9.94,均P<0.05),鸡翅型左心耳者中重度缺血性脑卒中风险降低71%(OR=0.29,95%CI:0.06~0.88,P<0.05)。结论仙人掌型左心耳及增大的LAD是非瓣膜病心房颤动患者发生中重型缺血性脑卒中的独立预测因子。Objective To investigate the relationship between left atrial appendage(LAA)morphology and function and the severity of first ischemic stroke in patients with non-valvular atrial fibrillation(AF).Methods 136 AF patients with first ischemic stroke were enrolled and divided into mild group(n=60)and moderate-severe group(n=76)according to the National Institutes of Health Stroke Scale scores.The morphology of LAA,maximum diameter of LAA(LAA-MD),LAA volume,LAA peak emptying velocity(LAA-PEV),LAA thrombus and spontaneous echo contrast were determined by transesophageal echocardiography.The left atrial diameter(LAD)was measured by transthoracic echocardiography.Results There were more cactus-type LAA in moderate-severe group and more chicken wing-type LAA in mild group(P<0.05).CHA2DS2-VASc score and the incidence of persistent AF and AF rhythm on admission were significantly higher in moderate-severe group than in mild group(all P<0.05).LAD was significantly larger and LAA-PEV was significantly lower in moderate-severe group than in mild group(all P<0.05).Multivariate logistic model analysis showed cactus-type LAA(OR=3.17,95%CI:1.67~8.75,P<0.05)and LAD(OR=1.34,95%CI:1.74~9.94,P<0.05)were predictors of moderate to severe ischemic stroke.The risk of moderate to severe ischemic stroke reduced by 71%in AF patients with chicken wing-type LAA.Conclusion Cactus-type LAA and increased LAD are independent risk factors of moderate to severe ischemic stroke in patients with non-valvular AF.

关 键 词：左心耳 心房颤动 缺血性脑卒中 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R541.75[医药卫生—临床医学]