右心声学造影联合房颤鉴别评分可提高对心源性脑梗死的预测价值  

Predictive value of right heart contrast echocardiography combined with score for the targeting of atrial fibrillation in cardiac embolism

作　　者：刘丁铭 程亚玲 杨红祥 甘萍 文俊杰 LIU Dingming;CHENG Yaling;YANG Hongxiang;GAN Ping;WEN Junjie(Department of Cardiology,West China-Guang’an Hospital,Sichuan University,Guang'an 638000,China)

机构地区：[1]四川大学华西广安医院心内科,四川广安638000

出　　处：《分子影像学杂志》2023年第4期682-687,共6页Journal of Molecular Imaging

基　　金：四川省转移支付项目(2021ZYZFSY01);广安市科技创新指导性计划项目(2021zdxjh13zzz)。

摘　　要：目的探究右心声学造影联合房颤鉴别评分(STAF)对心源性脑梗死(CE)预测价值。方法回顾性分析2017年8月~2021年8月医院收治149例CE患者及93例非心源性脑梗死(NCE)患者资料,分别作为CE组与NCE组。患者均接受右心声学造影及STAF,比较两组患者右心声学造影结果及STAF,分析右心声学造影联合STAF对CE的预测价值;CE患者随访1年,评估CE患者预后情况,分析CE患者预后影响因素。结果CE组患者1级+2级+3级右向左分流分级、卵圆孔未闭阳性率、卵圆孔长径、分流口内径均高于NCE组(P<0.05);CE组患者STAF高于NCE组患者(P<0.05);ROC曲线显示右向左分流分级、卵圆孔未闭阳性率、卵圆孔长径、分流口内径、STAF用于CE预测曲线下面积分别为0.582、0,570、0.679、0.808、0.750,各指标联合AUC值为0.905;单因素与多元Logistic回归分析显示房颤、总胆固醇、纤维蛋白原不是CE患者预后影响因素(P>0.05),入院时NIHSS评分、卵圆孔未闭阳性率、卵圆孔长径、STAF是CE患者预后影响因素(P<0.05)。结论右心声学造影联合STAF有助于提高心源性脑梗死预测价值。Objective To investigate the predictive value of right heart contrast echocardiography combined with the score for the targeting of atrial fibrillation(STAF)in cardiac embolism(CE).Methods We retrospectively analyzed the data of 149 patients with CE(CE group)and 93 patients with non-cardiac embolism(NCE group)who were admitted to the hospital from August 2017 to August 2021.The results of right heart contrast echocardiography and STAF scores in the two groups were compared.The predictive value of right heart contrast echocardiography combined with STAF in CE was analyzed.Patients with CE were followed up for 1 year to evaluate the prognosis.The prognostic factors in patients with CE were analyzed.Results The proportions of patients with grade 1,grade 2 and grade 3 right-to-left shunt,the positive rate of patent foramen ovale,long diameter of foramen ovale,and diameter of shunt orifice in CE group were higher/larger than those in NCE group(P<0.05).The STAF score of CE group was higher than that of NCE group(P<0.05).ROC curve analysis showed that the area under the curve values of right-to-left shunt grade,positive rate of patent foramen ovale,long diameter of foramen ovale,diameter of shunt orifice,STAF and their combination to predict CE were 0.582,0.570,0.679,0.808,0.750 and 0.905.Univariate analysis and multivariate logistic regression analysis found that the NIHSS score at admission,the positive rate of patent foramen ovale,long diameter of foramen ovale,and STAF were prognostic factors in patients with CE(P<0.05).Conclusion Right heart contrast echocardiography combined with STAF is beneficial to predict CE.

关 键 词：右心声学造影 房颤鉴别评分 心源性脑梗死 预测价值 

分 类 号：R445.1[医药卫生—影像医学与核医学] R541.75[医药卫生—诊断学] R743.3[医药卫生—临床医学]