Korhonen Miika, Muuronen Antti, Arponen Otso, Mustonen Pirjo, Hedman Marja, Jäkälä Pekka, Vanninen Ritva, Taina Mikko
Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
Department of Cardiology, Keski-Suomi Central Hospital, Jyväskylä, Finland.
PLoS One. 2015 Mar 9;10(3):e0118822. doi: 10.1371/journal.pone.0118822. eCollection 2015.
The left atrial appendage (LAA) is the typical origin for intracardiac thrombus formation. Whether LAA morphology is associated with increased stroke/TIA risk is controversial and, if it does, which morphological type most predisposes to thrombus formation. We assessed LAA morphology in stroke patients with cryptogenic or suspected cardiogenic etiology and in age- and gender-matched healthy controls. LAA morphology and volume were analyzed by cardiac computed tomography in 111 patients (74 males; mean age 60 ± 11 years) with acute ischemic stroke of cryptogenic or suspected cardiogenic etiology other than known atrial fibrillation (AF). A subgroup of 40 patients was compared to an age- and gender-matched control group of 40 healthy individuals (21 males in each; mean age 54 ± 9 years). LAA was classified into four morphology types (Cactus, ChickenWing, WindSock, CauliFlower) modified with a quantitative qualifier. The proportions of LAA morphology types in the main stroke group, matched stroke subgroup, and control group were as follows: Cactus (9.0%, 5.0%, 20.0%), ChickenWing (23.4%, 37.5%, 10.0%), WindSock (47.7%, 35.0%, 67.5%), and CauliFlower (19.8%, 22.5%, 2.5%). The distribution of morphology types differed significantly (P<0.001) between the matched stroke subgroup and control group. The proportion of single-lobed LAA was significantly higher (P<0.001) in the matched stroke subgroup (55%) than the control group (6%). LAA volumes were significantly larger (P<0.001) in both stroke study groups compared to controls patients. To conclude, LAA morphology differed significantly between stroke patients and controls, and single-lobed LAAs were overrepresented and LAA volume was larger in patients with acute ischemic stroke of cryptogenic or suspected cardiogenic etiology.
左心耳（LAA）是心内血栓形成的典型起源部位。LAA形态是否与中风/短暂性脑缺血发作（TIA）风险增加相关存在争议，若有关联，哪种形态类型最易引发血栓形成也尚无定论。我们评估了病因不明或疑似心源性病因的中风患者以及年龄和性别匹配的健康对照者的LAA形态。通过心脏计算机断层扫描对111例（74例男性；平均年龄60±11岁）病因不明或疑似心源性病因（已知房颤（AF）除外）的急性缺血性中风患者的LAA形态和容积进行分析。将40例患者的亚组与40名年龄和性别匹配的健康个体组成的对照组（每组21名男性；平均年龄54±9岁）进行比较。LAA被分为四种形态类型（仙人掌型、鸡翅型、风袋型、菜花型），并使用定量限定词进行改良。主要中风组、匹配中风亚组和对照组中LAA形态类型的比例如下：仙人掌型（9.0%、5.0%、20.0%），鸡翅型（23.4%、37.5%、10.0%），风袋型（47.7%、35.0%、67.5%），菜花型（19.8%、22.5%、2.5%）。匹配中风亚组和对照组之间形态类型的分布存在显著差异（P<0.001）。匹配中风亚组中单叶LAA的比例（55%）显著高于对照组（6%）（P<0.001）。与对照组患者相比，两个中风研究组的LAA容积均显著更大（P<0.001）。总之，中风患者和对照组之间的LAA形态存在显著差异，单叶LAA在病因不明或疑似心源性病因的急性缺血性中风患者中占比过高，且LAA容积更大。
