Department of Cardiology and Pneumology, University of Göttingen, Göttingen, Germany.
Stroke. 2011 Dec;42(12):3643-5. doi: 10.1161/STROKEAHA.111.632836. Epub 2011 Oct 13.
We assessed whether echocardiography can predict paroxysmal atrial fibrillation (PAF) in patients with cerebral ischemia presenting in sinus rhythm.
Within the prospective Find-AF cohort, 193 consecutive patients with cerebral ischemia and sinus rhythm on presentation had evaluation of echocardiographic parameters of left atrial size and function. PAF was diagnosed by 7-day Holter monitoring.
In 26 patients with PAF, late diastolic Doppler (A) and tissue Doppler (a') velocities were lower whereas left atrial diameter, left atrial volume index (LAVI), LAVI/A, and LAVI/a' were larger (P<0.05 for all) than they were in 167 patients without PAF. In multivariate models A, a', LAVI/A, and LAVI/a' predicted the presence of PAF. Area under the receiver operating characteristic curve to diagnose PAF was highest for LAVI/a' (0.813 [0.738; 0.889]). A previously suggested cut-off of LAVI/a'<2.3 had 92% sensitivity, 55.8% specificity, and 98% negative predictive value for PAF.
LAVI/a'<2.3 can effectively rule out PAF in patients with cerebral ischemia.
本研究旨在评估经胸超声心动图能否预测以窦性心律起病的脑缺血患者阵发性心房颤动（PAF）。
在前瞻性 Find-AF 队列中，193 例以窦性心律起病的脑缺血患者接受了左心房大小和功能的超声心动图参数评估。通过 7 天动态心电图监测诊断 PAF。
在 26 例 PAF 患者中，舒张晚期多普勒（A）和组织多普勒（a'）速度较低，而左心房直径、左心房容积指数（LAVI）、LAVI/A 和 LAVI/a'较大（P<0.05）。多变量模型 A、a'、LAVI/A 和 LAVI/a' 预测 PAF 的存在。LAVI/a' 诊断 PAF 的受试者工作特征曲线下面积最高（0.813 [0.738; 0.889]）。先前提出的 LAVI/a'<2.3 截断值对 PAF 的敏感性为 92%，特异性为 55.8%，阴性预测值为 98%。
LAVI/a'<2.3 可有效排除脑缺血患者的 PAF。
