Uslu Nevzat, Nurkalem Zekeriya, Orhan Ahmet L, Aksu Huseyin, Sari Ibrahim, Soylu Ozer, Gurdogan Muhammed, Topcu Kadir, Gorgulu Sevket, Eren Mehmet
Siyami Ersek Thoracic and Cardiovascular Surgery Center, Cardiology Department, Istanbul, Turkey.
Tohoku J Exp Med. 2006 Apr;208(4):291-8. doi: 10.1620/tjem.208.291.
Systemic embolization is a potential complication in patients with thrombi situated in the left atrium and particularly, in the left atrial appendage (LAA). Reduced LAA contraction velocities, determined by the transesophageal echocardiography (TEE), are associated with increased risk of LAA spontaneous echocontrast and thrombus formation, and a history of systemic embolism. However, TEE remains a semi-invasive procedure, limiting its serial application as a screening tool. Therefore, it is desirable to obtain information regarding LAA function by transthoracic echocardiography in patients having cardioembolic stroke. The present study was designed to investigate various echocardiographic variables for patients with stroke to predict LAA dysfunction, reflected as reduced LAA contraction velocity. We studied a total of 61 patients with newly diagnosed acute embolic stroke (42 patients) and transient ischemic attack (19 patients). Computerized tomographic scanning was performed for the diagnosis of embolic stroke. Left atrial functional parameters determined by transthoracic echocardiography, such as left atrial active emptying fraction and acceleration slope of mitral inflow A wave, had significant correlations with the LAA contraction velocity (r = 0.57, p < 0.001; r = 0.54, p < 0.001, respectively). Left atrial volume index, left atrial active emptying volume and left atrial fractional shortening were also correlated with LAA contraction velocity (r = -0.44, p < 0.001; r = 0.38, p = 0.003; r = 0.37, p = 0.004, respectively). In conclusion, transthoracic echocardiography can provide valuable and reliable information about the LAA contraction velocity in stroke patients with sinus rhythm. This finding gives new insights for the appropriate strategy in the evaluation of an acute ischemic stroke.
系统性栓塞是左心房尤其是左心耳(LAA)有血栓的患者的一种潜在并发症。经食管超声心动图(TEE)测定的LAA收缩速度降低与LAA自发显影及血栓形成风险增加以及系统性栓塞病史相关。然而,TEE仍是一种半侵入性检查,限制了其作为筛查工具的连续应用。因此,对于患有心源性栓塞性卒中的患者,期望通过经胸超声心动图获取有关LAA功能的信息。本研究旨在调查卒中患者的各种超声心动图变量,以预测反映为LAA收缩速度降低的LAA功能障碍。我们共研究了61例新诊断的急性栓塞性卒中患者(42例)和短暂性脑缺血发作患者(19例)。进行计算机断层扫描以诊断栓塞性卒中。经胸超声心动图测定的左心房功能参数,如左心房主动排空分数和二尖瓣流入A波加速斜率,与LAA收缩速度显著相关(分别为r = 0.57,p < 0.001;r = 0.54,p < 0.001)。左心房容积指数、左心房主动排空容积和左心房缩短分数也与LAA收缩速度相关(分别为r = -0.44,p < 0.001;r = 0.38,p = 0.003;r = 0.37,p = 0.004)。总之,经胸超声心动图可为窦性心律的卒中患者提供有关LAA收缩速度的有价值且可靠的信息。这一发现为急性缺血性卒中评估的适当策略提供了新的见解。