经食管超声心动图检查结果与心房颤动患者脑梗死亚型的关系。

Relation of transesophageal echocardiographic findings to subtypes of cerebral infarction in patients with atrial fibrillation.

作者信息

Shinokawa N, Hirai T, Takashima S, Kameyama T, Obata Y, Nakagawa K, Asanoi H, Inoue H

机构信息

The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, Japan.

出版信息

Clin Cardiol. 2000 Jul;23(7):517-22. doi: 10.1002/clc.4960230710.

DOI:10.1002/clc.4960230710

PMID:10894440

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6654812/

Abstract

BACKGROUND

Transesophageal echocardiography (TEE) has been used to identify the potential risk for cardiogenic embolism in patients with atrial fibrillation (AF). However, ischemic stroke in patients with AF is not always attributable to embolism. Identification of the risk of embolic versus atherothrombotic stroke should lead to the optimal individualized management of patients with AF.

HYPOTHESIS

The goal of the study was to determine the relation between cortical infarction and perforating infarction and TEE findings in patients with AF.

METHODS

We investigated the clinical usefulness of TEE in the risk stratification of clinical subtyping of the cerebral infarctions which were divided into two territories of the cortical branch (cortical infarction due to embolism) and deep perforators (perforating infarction due to atherothrombosis). Left atrial spontaneous echo contrast, peak flow velocity in the left atrial appendage, and generalized atherosclerosis as estimated by the intima-media wall thickness of the thoracic aorta were assessed by TEE in 118 consecutive patients with either paroxysmal (n = 44) or chronic (n = 74) AF. All patients underwent either brain computed tomography or magnetic resonance imaging.

RESULTS

Cortical and perforating infarction was found in 39 and 18% of patients, respectively. The grade of spontaneous echo contrast was higher in patients with than in those without cortical infarction (p < 0.05). In contrast, patients with perforating infarction showed significant increase in the aortic wall thickness when compared with patients without perforating infarction (p < 0.05). In addition, multivariate logistic analysis revealed that spontaneous echo contrast was an independent predictor of cortical infarction, while intima-media wall thickness of the aorta, hypertension, and age were useful in predicting the risk of perforating infarction.

CONCLUSIONS

Transesophageal echocardiography has a potential role in the risk stratification for cortical and perforating infarction in patients with AF.

摘要

背景

经食管超声心动图（TEE）已被用于识别心房颤动（AF）患者发生心源性栓塞的潜在风险。然而，AF患者的缺血性卒中并不总是由栓塞引起的。识别栓塞性与动脉粥样硬化血栓形成性卒中的风险应能实现对AF患者的最佳个体化管理。

假设

本研究的目的是确定AF患者皮质梗死和穿支梗死与TEE检查结果之间的关系。

方法

我们研究了TEE在脑梗死临床亚型风险分层中的临床实用性，脑梗死分为皮质支的两个区域（栓塞性皮质梗死）和深部穿支（动脉粥样硬化血栓形成性穿支梗死）。通过TEE对118例阵发性（n = 44）或慢性（n = 74）AF患者的左心房自发显影、左心耳峰值流速以及通过胸主动脉内膜中层厚度评估的全身性动脉粥样硬化进行了评估。所有患者均接受了脑部计算机断层扫描或磁共振成像检查。

结果

分别在39%和18%的患者中发现了皮质梗死和穿支梗死。有皮质梗死的患者自发显影分级高于无皮质梗死的患者（p < 0.05）。相比之下，与无穿支梗死的患者相比，有穿支梗死的患者主动脉壁厚度显著增加（p < 0.05）。此外，多因素逻辑分析显示，自发显影是皮质梗死的独立预测因素，而主动脉内膜中层厚度、高血压和年龄有助于预测穿支梗死的风险。