左心房内径和左心室射血分数与慢性心力衰竭患者发生缺血性脑卒中的相关性研究

Relationship of left atrial diameter and left ventricular ejection fraction with cerebral ischemic stroke in CHF patients

目的本研究探讨左心房内径、LVEF与老年慢性心力衰竭(CHF)患者发生缺血性脑卒中的相关性。方法选取2018年1月1日~2019年12月31日江苏省苏北人民医院住院治疗未合并心房颤动(AF)或心房扑动(AFL)的老年CHF患者149例,依据有无急性缺血性脑卒中分为脑卒中组62例和对照组87例,比较2组一般临床资料和超声心动图检查指标,采用logistic回归分析老年CHF患者发生缺血性脑卒中的独立危险因素。结果与对照组比较,脑卒中组尿酸、左心房内径、左心室内径、室间隔厚度明显升高,纤维蛋白原水平明显降低,差异有统计学意义(P<0.05,P<0.01)。校正相关因素后,logistic回归分析显示,左心房内径是无AF/AFL的老年CHF患者发生缺血性脑卒中的独立危险因素(OR=1.224,95%CI:1.120~1.338,P=0.000)。ROC曲线分析显示,左心房内径预测无AF/AFL的老年CHF患者发生缺血性脑卒中的曲线下面积为0.772(95%CI:0.697~0.848,P=0.000);约登指数发现,左心房内径预测无AF/AFL的老年CHF患者发生缺血性脑卒中的最佳临界值为35.5 mm,敏感性为0.823,特异性为0.621。结论左心房内径增大是未合并AF/AFL的老年CHF患者发生缺血性脑卒中的独立危险因素。

Objective To study the relationship of left atrial diameter and left ventricular ejection fraction with cerebral ischemic stroke in elderly chronic heart failure(CHF) patients.Methods One hundred and forty-nine elderly CHF patients without AF or atrial flutter admitted to Northern Jiangsu People’s Hospital from 2018-01-01 to 2019-12-31 were divided into control group(n=87) and cerebral ischemic stroke group(n=62).Their general clinical data and echocardiographic parameters were compared.The independent risk factors for cerebral ischemic stroke in elderly CHF patients were analyzed by logistic regression analysis.Results The serum UA level was significantly higher, the left atrial diameter and left ventricular diameter were significantly longer, the ventricular septal thickness was significantly thicker while the serum fibrinogen level was significantly lower in cerebral ischemic stroke group than in control group(P<0.05,P<0.01).Logistic regression analysis showed that left atrial diameter was an independent risk factor for cerebral ischemic stroke in elderly CHF patients without AF or atrial flutter after adjustment for related factors(OR=1.224,95%CI:1.120-1.338,P=0.000).ROC curve analysis displayed that the AUC for left atrium diameter in predicting cerebral ischemic stroke in elderly CHF patients without AF or atrial flutter was 0.772(95%CI:0.697-0.848,P=0.000).Youden index revealed that the optimal cut-off value of left atrial diameter for predicting cerebral ischemic stroke in elderly CHF patients without AF or atrial flutter was 35.5 mm with a sensitivity of 0.823 and a specificity of 0.621.Conclusion Enlarged left atrial diameter is an independent risk factor for cerebral ischemic stroke in elderly CHF patients without AF or atrial flutter.