Hoshi Yoko, Nozawa Yukinaga, Ogasawara Makoto, Yuda Satoshi, Sato Shoko, Sakasai Takuya, Oka Makoto, Katayama Harumi, Sato Masaya, Kouzu Hidemichi, Nishihara Masahiro, Doi Atsushi, Nishimiya Takatoshi, Miura Tetsuji
Division of Laboratory Diagnosis, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan.
Echocardiography. 2014 Feb;31(2):140-8. doi: 10.1111/echo.12329. Epub 2013 Jul 30.
A considerable number of patients with atrial fibrillation (AF) develop cardioembolic stroke (CE) despite low CHADS2 score. We examined the possibility that use of the atrial electromechanical interval (AEMI) improves prediction of CE in patients with paroxysmal AF (PAF), particularly those with low CHADS2 score.
We consecutively enrolled 108 patients with nonvalvular PAF and 52 healthy subjects as controls. The PAF patients were divided into 2 groups depending on presence (n = 36) or absence (n = 72) of the history of CE. Left atrial (LA) volume index (LAVI), peak myocardial velocity during late diastole (a'), and AEMI as time from onset of P-wave to onset of lateral a' were measured.
Patients with PAF had significantly larger LAVI, longer AEMI, and lower lateral a' than those in controls. Area under the curves for LAVI, lateral a', and AEMI for identifying patients with PAF were 0.70, 0.69, and 0.88, respectively. Multivariate logistic regression analysis indicated that age, use of antiarrhythmic drugs, and AEMI, but not LAVI or a', were independently associated with history of CE in patients with PAF. PAF patients were categorized into low risk by CHADS2 score (i.e. CHADS2 score = 0 or 1, n = 60), those with prolonged AEMI (>82 msec) had significantly higher rates of CE than those with ≤ 82 msec (48% vs. 15%, P < 0.05).
As compared with echocardiographic parameters of LA size and LA function, AEMI appears to be more useful for identifying PAF patients. AEMI may enable to detect high risk PAF patients, especially those categorized into low risk by CHADS2 score.
相当一部分心房颤动（AF）患者尽管CHADS2评分较低，但仍发生心源性栓塞性卒中（CE）。我们研究了使用心房机电间期（AEMI）改善阵发性房颤（PAF）患者，尤其是CHADS2评分较低患者CE预测的可能性。
我们连续纳入108例非瓣膜性PAF患者和52例健康受试者作为对照。PAF患者根据是否有CE病史分为两组（有CE病史组n = 36，无CE病史组n = 72）。测量左心房（LA）容积指数（LAVI）、舒张末期心肌峰值速度（a'）以及从P波起始至侧壁a'起始的时间即AEMI。
PAF患者的LAVI显著更大、AEMI更长且侧壁a'更低。LAVI、侧壁a'和AEMI用于识别PAF患者的曲线下面积分别为0.70、0.69和0.88。多因素逻辑回归分析表明，年龄、抗心律失常药物的使用以及AEMI，而非LAVI或a'，与PAF患者的CE病史独立相关。PAF患者根据CHADS2评分分为低风险组（即CHADS2评分为0或1，n = 60），AEMI延长（>82毫秒）的患者CE发生率显著高于AEMI≤82毫秒的患者（48%对15%，P < 0.05）。
与LA大小和LA功能的超声心动图参数相比，AEMI似乎对识别PAF患者更有用。AEMI可能有助于检测高危PAF患者，尤其是那些根据CHADS2评分分类为低风险的患者。
