左心耳造影剂滞留与非瓣膜性心房颤动相关脑卒中风险的关联

Correlation Between Left Atrial Appendage Contrast Agent Retention and Stroke Risk in Non-valvular Atrial Fibrillation Patients

目的:探索左心耳造影剂滞留与非瓣膜性心房颤动(房颤)相关脑卒中风险的关联。方法:选取2019年1月至2022年6月于新疆医科大学第一附属医院行左心耳封堵术的非瓣膜性房颤患者204例,按照术后有无左心耳造影剂滞留,造影剂滞留患者和无造影剂滞留患者分别有76例(37.3%)和128例(62.7%),脑卒中患者和非脑卒中患者分别有87例(42.6%)和117例(57.4%),这两类患者中造影剂滞留患者分别有64例(73.6%)和12例(10.3%)。规范采集经胸超声心动图、经食道超声心动图、经皮左心耳封堵术中左心耳造影图像,收集患者基线资料,通过倾向性评分匹配调整混杂因素,分析匹配后左心耳造影剂滞留与房颤相关脑卒中风险的关联。结果:共100例患者按1:1的比例匹配成功,其中造影剂滞留患者和无造影剂滞留患者各50例,脑卒中患者和非脑卒中患者分别有55例和45例;其平均年龄为(70.5±10.5)岁,男性占56.0%。匹配后的多因素Logistic回归分析显示,左心耳造影剂滞留(OR=66.125,95%CI:6.880~635.551,P<0.001)、CHA2DS2-VASc评分(OR=3.263,95%CI:1.621~6.568,P=0.001)、左心耳深度之和(OR=1.128,95%CI:1.042~1.120,P=0.003)、左心耳开口直径之和(OR=0.773,95%CI:0.665~0.898,P=0.001)均与房颤相关脑卒中风险有关。结论:在非瓣膜性房颤患者中,左心耳造影剂滞留与房颤相关脑卒中风险有关,造影剂滞留患者的左心耳深度之和较大,左心耳开口直径之和较小。

Objectives:To explore the relationship between post-operative contrast agent retention in left atrial appendage and stroke risk in non-valvular atrial fibrillation patients undergoing left atrial appendage occlusion.Methods:204 patients with non-valvular atrial fibrillation who underwent left atrial appendage occlusion operation in the First Affiliated Hospital of Xinjiang Medical University from January 2019 to June 2022 were divided into patients with contrast retention(n=76)and patients without contrast agent retention(n=128)according to the presence or absence of postoperative left atrial appendage contrast agent retention.There were 87(42.6%)patients with stroke and 117(57.4%)patients without stroke,and there were 64(73.6%)and 12(10.3%)patients with contrast agent retention respectively.The images of transthoracic echocardiography,transesophageal echocardiography and left atrial appendage angiography during percutaneous left atrial appendage occlusion were collected.The baseline data of patients were collected,and the confounding factors were adjusted by propensity score matching.The relationship between left atrial appendage contrast agent retention post left atrial appendage occlusion operation and atrial fibrillation related stroke after matching was analyzed.Results:A total of 100 patients were successfully matched in a 1:1 ratio,there were 50 patients with or without contrast retention respectively,55 patients had stroke.The mean age of the matched population was(70.5±10.5)years,56.0%were male.The results of the post-matching multifactorial logistic regression analysis showed that post-operative contrast agent retention in left atrial appendage(OR=66.125,95%CI:6.880-635.551,P<0.001),CHA2DS2-VASc score(OR=3.263,95%CI:1.621-6.568,P=0.001),the sum of left atrial appendage depth(OR=1.128,95%CI:1.042-1.120,P=0.003)and the sum of left atrial appendage opening diameter(OR=0.773,95%CI:0.665-0.898,P=0.001)were independent risk factors of stroke in patients with non-valvular atrial fibrillation who underwent left atrial appendage occlusion operation.Conclusions:In patients with nonvalvular atrial fibrillation,left atrial appendage contrast agent retention is associated with the risk of atrial fibrillation related stroke,and patients with contrast agent retention have a larger sum of left atrial appendage depths and a smaller sum of left atrial appendage opening diameters.