E/Em对心房颤动患者并发急性缺血性脑卒中的预测价值

Predictive value of E/Em on acute ischemic stroke in patients with atrial fibrillation

目的:研究预测心房颤动患者发生急性缺血性脑卒中的相关因素。方法:回顾性分析32例新发缺血性脑卒中的心房颤动患者(研究组)的临床资料,同期入选的30例无缺血性脑卒中的心房颤动患者作对照(对照组)。急性缺血性脑卒中患者均在急性期内完善头颅MRI检查。所有患者均行经胸超声心动图检查,测量其二尖瓣舒张早期血流峰速度E及二尖瓣环侧壁舒张早期运动峰速度Em,计算E/Em值。记录患者所有临床资料,分析心房颤动患者发生急性缺血性脑卒中的危险因素,研究E/Em对心房颤动患者急性缺血性脑卒中的预测价值,并通过受试者工作特征(ROC)曲线分析E/Em预测心房颤动患者发生急性缺血性脑卒中的灵敏度和特异度。结果:两组患者基线资料均衡。与对照组患者比较,研究组患者年龄较大,女性比例较高,合并高血压病者较多,但差异无统计学意义;超声心动图资料对比,研究组患者Em值较低,E/Em比值较高,差异具有统计学意义(P<0.05);在研究组患者中,E/Em比值越高,新发急性缺血性脑卒中比例越高;多因素回归分析显示,E/Em比值是AF患者新发缺血性脑卒中的独立危险因素。E/Em截断值取11.5时,预测AF患者并发急性缺血性脑卒中的ROC曲线下面积最大,为0.740(95%CI为0.645~0.835,P<0.05),敏感度和特异度分别为65.5%、81.7%。结论:E/Em对预测心房颤动患者急性缺血性脑卒中的发生具有较好的应用价值。

Objective：To study the predictive factors of acute ischemic stroke in patients with atrial fibrillation.Method：The clinical data of 32 patients with atrial fibrillation（group A）who were newly diagnosed with ischemic stroke were analyzed.30 atrial fibrillation patients without ischemic stroke were enrolled in the same period as control group（group B）.The patients with acute ischemic stroke have completed the cranial MRI examination during the acute period.All patients underwent transthoracic echocardiography,and their mitral valve diastolic blood flow peak velocity E and mitral annulus wall diastolic motion peak velocity Em were measured,and E/Em value was calculated.All records of clinical data,analysis of risk factors in patients with acute ischemic stroke with atrial fibrillation,E/Em fibrillation predictive value in patients with acute ischemic stroke of the atrium,and through the receiver operating characteristic（ROC）sensitivity of E/Em prediction of atrial fibrillation patients with acute ischemic stroke and specificity analysis curve were analyzed.Result：The baseline data of the two groups were balanced.Compared with group B,patients in group A were older,more female,and a higher proportion of hypertension,but there was no significant difference.Patients in group A had lower Em value and higher E/Em ratio,the difference was statistically significant（P〈0.05）.Of the patients in group A,the higher the ratio of E/Em is,the more onset of acute ischemic stroke occurs.Multivariate regression analysis showed that the ratio of E/Em is the independent risk factors of AF patients with new onset ischemic stroke.When the cut-off value of E/Em was 11.5,the area under the ROC curve of AF patients with acute ischemic stroke was the largest,which was 0.740（95%CI0.645-0.835,P〈0.05）,and the sensitivity and specificity were 65.5%and 81.7%,respectively.Conclusion：E/Em could be useful in predicting the occurrence of acute ischemic stroke in patients with atrial fibrillation.