左心耳容积对急性缺血性脑卒中后阵发性房颤的预测价值
摘要
目的探讨左心耳容积对急性缺血性脑卒中后并发阵发性房颤的预测价值。方法 115例急性缺血性脑卒中患者根据既往史及卒中后24 h长程动态心电图结果分为阵发性房颤组(45例)和非阵发性房颤组(70例),测量两组左心耳最大容积,采用多因素二元Logistics回归分析法分析急性缺血性脑卒中后阵发性房颤发生的危险因素,ROC曲线分析左心耳容积对卒中后阵发性房颤的预测价值。结果阵发性房颤组、非阵发性房颤组左心耳容积分别为(7.0±2.7)、(4.2±1.3) mL,两组比较,P <0.05。多因素二元Logistics回归分析显示,左心耳容积为急性缺血性脑卒中后并发阵发性房颤的独立危险因素(P <0.05)。左心耳容积> 5.25 mL时对急性缺血性脑卒中后阵发性房颤的预测价值最高(曲线下面积为0.825),灵敏度和特异度分别为66.7%和85.7%。结论左心耳容积是急性缺血性脑卒中后并发阵发性房颤的独立危险因素,其可以预测卒中后阵发性房颤的发生。
引文
[1]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(2):246-257.
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[8]Hart rg HJ.Atrial fibrillation and stroke:concepts and controversies[J].Stroke,2001,32(3):803-808.
[9]Tanaka K,Koga M,Sato K,et al.Three-dimensional analysis of the left atrial appendage for detecting paroxysmal atrial fibrillation in acute ischemic stroke[J].INT J Stroke,2014,9(8):1045-1051.
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[11]郑桂安,林春艺,翁兰.左心耳体积对心房颤动导管射频消融术后复发的预测价值[J].中华心血管病杂志,2017,45(11):924-929.
[12]Jauch EC,Saver JL,Adams HJ,et al.Guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the American Heart Association/A-merican Stroke Association[J].Stroke,2013,44(3):870-947.
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[14]Alhadramy O,Jeerakathil TJ,Majumdar SR,et al.Prevalence and predictors of paroxysmal atrial fibrillation on holter monitor in patients with stroke or transient ischemic attack[J].Stroke,2010,41(11):2596-2600.
[15]Roche F,Gaspoz JM,Da costa A,et al.Frequent and prolonged asymptomatic episodes of paroxysmal atrial fibrillation revealed by automatic long-term event recorders in patients with a negative 24-hour Holter[J].Pacing CLIN Electrophysiol,2002,25(11):1587-1593.
[16]Montserrat S,Gabrielli L,Borras R,et al.Left atrial size and function by three-dimensional echocardiography to predict arrhythmia recurrence after first and repeated ablation of atrial fibrillation[J].EUR Heart J Cardiovasc Imaging,2014,15(5):515-522.
[17]Dibiase L,Burkhardt JD,Mohanty P,et al.Left atrial appendage:an underrecognized trigger site of atrial fibrillation[J].Circulation,2010,122(2):109-118.
[18]Chen R,Wu X,Jin H,et al.Assessment of left atrial appendage morphology and function in patients with Non-valvular paroxysmal atrial fibrillation with different rhythms using Real-Time 3Dtransesophageal echocardiography[J].Ultrasound MED Biol,2016,42(1):118-124.
[19]温兆赢,张兆琪,于薇.多排CT对左心房和左心耳容积和功能的评价[J].第三军医大学学报,2010,32(12):1336-1339.
[20]Taina M,Korhonen M,Haataja M,et al.Morphological and volumetric analysis of left atrial appendage and left atrium:cardiac computed tomography-based reproducibility assessment[J].PLo SOne,2014,9(7):e101580.
[2]Wolf PA,Abbott RD,Kannel WB.Atrial fibrillation as an Independent risk factor for stroke:the framingham study[J].Stroke,1991,22(8):983-988.
[3]Roy D,Marchand E,GagnéP,et al.Usefulness of anticoagulant therapy in the prevention of embolic complications of atrial fibrillation[J].Am Heart J,1986,112(5):1039-1043.
[4]Okada Y,Shibazaki K,Kimura K,et al.Brain natriuretic peptide as a predictor of delayed atrial fibrillation after ischaemic stroke and transient ischaemic attack[J].EUR J Neurol,2010,17(2):326-331.
[5]Lowe GD.Can haematological tests predict cardiovascular risk?The 2005 kettle lecture[J].BR J Haematol,2006,133(3):232-250.
[6]Shibazaki K,Kimura K,Fujii S,et al.Brain natriuretic peptide levels as a predictor for new atrial fibrillation during hospitalization in patients with acute ischemic stroke[J].Am J Cardiol,2012,109(9):1303-1307.
[7]Fujii S,Shibazaki K,Kimura K,et al.A simple score for predicting paroxysmal atrial fibrillation in acute ischemic stroke[J].JNeurol SCI,2013,328(1/2):83-86.
[8]Hart rg HJ.Atrial fibrillation and stroke:concepts and controversies[J].Stroke,2001,32(3):803-808.
[9]Tanaka K,Koga M,Sato K,et al.Three-dimensional analysis of the left atrial appendage for detecting paroxysmal atrial fibrillation in acute ischemic stroke[J].INT J Stroke,2014,9(8):1045-1051.
[10]Shimizu T,Takada T,Shimode A,et al.Association between paroxysmal atrial fibrillation and the left atrial appendage ejection fraction during sinus rhythm in the acute stage of stroke:a transesophageal echocardiographic study[J].J Stroke Cerebrovasc DIS,2013,22(8):1370-1376.
[11]郑桂安,林春艺,翁兰.左心耳体积对心房颤动导管射频消融术后复发的预测价值[J].中华心血管病杂志,2017,45(11):924-929.
[12]Jauch EC,Saver JL,Adams HJ,et al.Guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the American Heart Association/A-merican Stroke Association[J].Stroke,2013,44(3):870-947.
[13]Sanna T,Diener HC,Passman RS,et al.Cryptogenic stroke and underlying atrial fibrillation[J].N ENGL J MED,2014,370(26):2478-2486.
[14]Alhadramy O,Jeerakathil TJ,Majumdar SR,et al.Prevalence and predictors of paroxysmal atrial fibrillation on holter monitor in patients with stroke or transient ischemic attack[J].Stroke,2010,41(11):2596-2600.
[15]Roche F,Gaspoz JM,Da costa A,et al.Frequent and prolonged asymptomatic episodes of paroxysmal atrial fibrillation revealed by automatic long-term event recorders in patients with a negative 24-hour Holter[J].Pacing CLIN Electrophysiol,2002,25(11):1587-1593.
[16]Montserrat S,Gabrielli L,Borras R,et al.Left atrial size and function by three-dimensional echocardiography to predict arrhythmia recurrence after first and repeated ablation of atrial fibrillation[J].EUR Heart J Cardiovasc Imaging,2014,15(5):515-522.
[17]Dibiase L,Burkhardt JD,Mohanty P,et al.Left atrial appendage:an underrecognized trigger site of atrial fibrillation[J].Circulation,2010,122(2):109-118.
[18]Chen R,Wu X,Jin H,et al.Assessment of left atrial appendage morphology and function in patients with Non-valvular paroxysmal atrial fibrillation with different rhythms using Real-Time 3Dtransesophageal echocardiography[J].Ultrasound MED Biol,2016,42(1):118-124.
[19]温兆赢,张兆琪,于薇.多排CT对左心房和左心耳容积和功能的评价[J].第三军医大学学报,2010,32(12):1336-1339.
[20]Taina M,Korhonen M,Haataja M,et al.Morphological and volumetric analysis of left atrial appendage and left atrium:cardiac computed tomography-based reproducibility assessment[J].PLo SOne,2014,9(7):e101580.