非瓣膜性持续性心房颤动患者缺血性脑卒中与左心耳功能的相关性分析

Correlation between ischemic stroke and left atrial appendage function in patients with non-valvular persistent atrial fibrillation

目的分析左心耳功能对非瓣膜性持续性心房颤动患者缺血性脑卒中的预测价值。方法回顾性分析2019年1月至2021年12月于聊城市人民医院心血管内科住院患者,均接受经食道超声心动图、头颅CT或磁共振检查,且诊断为持续性心房颤动。通过电子病历系统收集患者的基本信息和实验室检查结果,进行比较分析。结果本研究共纳入患者263例,年龄30~85岁,平均年龄(59.06±9.097)岁,合并缺血性脑卒(缺血性脑卒中组)70例,平均年龄(64.46±8.70)岁,未合并脑卒中(非脑卒中组)193例,平均年龄(57.10±9.69)岁。缺血性脑卒中组患者的平均年龄、胆固醇、高血压、冠状动脉粥样硬化性心脏病(冠心病)比例明显高于非脑卒中组(P<0.05),且低密度脂蛋白、左心耳排空峰值流速均低于无脑卒中组(P<0.05)。多因素Logistic回归分析显示左心耳排空峰值流速与缺血性脑卒中风险呈负相关(P=0.002),年龄、高血压病与缺血性脑卒中风险呈正相关(P<0.05)。ROC曲线分析显示,左心耳排空峰值流速预测缺血性脑卒中的最佳截断值为0.315 m/s,敏感性为65.7%,特异性为67.2%,AUC为0.686。结论左心耳排空峰值流速减低、高龄、高血压病为非瓣膜性持续性房颤患者缺血性脑卒中的独立危险因素。持续性心房颤动患者左心耳功能下降至0.315 m/s时,需警惕缺血性脑卒中的发生。

Objective To analyze the predictive value of function of left atrial appendage(LAA)to ischemic stroke in patients with non-valvular persistent atrial fibrillation(PeAF).Methods The patients were received transesophageal echocardiography(TEE),computerized tomography(CT)or magnetic resonance imaging(MRI),diagnosed as PeAF and analyzed retrospectively in Department of Cardiovascular Medicine in People’s Hospital of Liaocheng City from Jan.2019 to Dec.2021.The basic data and laboratory results were collected by using system of electronic medical record(EMR),and compared and analyzed.Results There were totally 263 patients included,aged from 30 to 85(mean age=59.06±9.097).The patients were divided into ischemic stroke group(IS group,n=70,mean age=64.46±8.70)and non-ischemic stroke(non-IS group,n=193,mean age=57.10±9.69).Age,cholesterol(CH),hypertension,and percentage of coronary heart disease(CHD)were significantly higher(P<0.05),and lowdensity lipoprotein(LDL)and LAA peak emptying velocity were lower(P<0.05)in IS group than those in non-IS group.The results of multi-factor Logistic regression analysis showed that LAA peak emptying velocity was negatively correlated to IS risk(P=0.002),and age and hypertension were positively correlated to IS risk(P<0.05).The results of ROC curve analysis showed that the optimal cutoff value of LAA peak emptying velocity was 0.315 m/s in predicting IS,sensitivity was 65.7%,specificity was 67.2%and AUC was 0.686.Conclusion The decreased LAA peak emptying velocity,advanced age and hypertension are independent risk factors of IS in patients with nonvalvularPeAF.Caution is warranted for IS occurrence when LAA peak emptying velocitydecreases to 0.315 m/s in patients with non-valvularPeAF.