Lee Jung Myung, Seo Jiwon, Uhm Jae-Sun, Kim Young Jin, Lee Hye-Jeong, Kim Jong-Youn, Sung Jung-Hoon, Pak Hui-Nam, Lee Moon-Hyoung, Joung Boyoung
Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Division of Cardiology, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea.
J Cardiovasc Electrophysiol. 2015 Sep;26(9):922-927. doi: 10.1111/jce.12710. Epub 2015 Jun 16.
A specific morphology of left atrial appendage (LAA) has been reported to be related to stroke in nonvalvular atrial fibrillation (AF) patients. However, the mechanism is not completely understood. This study evaluated whether a specific LAA morphology was related to stroke, and whether it was related to the change of flow velocity and size of LAA in AF patients.
The morphology, size, and flow velocity of LAA were evaluated in AF patients with ischemic strokes (stroke, n = 160) and age-matched AF patients without ischemic strokes (control, n = 200).
Compared with control, the stroke group had a larger LA dimension (4.5 ± 0.7 vs. 4.2 ± 0.6 cm, P < 0.001), larger LAA orifice area (5.3 ± 2.1 vs. 4.1 ± 1.7 cm , P < 0.001), and slower LAA flow velocity (37 ± 19 vs. 51 ± 20 cm/s, P < 0.001). The stroke group had the chicken wing type less frequently than the control (34% vs. 50%, P = 0.003). After an adjustment for multiple potential confounding factors, the chicken wing type LAA had a decreased stroke risk (odds ratio 0.34, 95% confidence interval 0.14-0.84, P = 0.020). Patients with a chicken wing LAA had a smaller LAA orifice area (4.4 ± 1.6 vs. 4.9 ± 2.2 cm , P = 0.013) and higher LAA velocity (55 ± 19 vs. 41 ± 20 cm/s, P < 0.001) than those with non-chicken wing LAA.
A chicken wing type of LAA was related to the less incidence of stroke. Our results suggest that the relationship between a specific LAA morphology and stroke might be partially explained by the change of the size and flow velocity of LAA.
据报道，左心耳（LAA）的特定形态与非瓣膜性心房颤动（AF）患者的中风有关。然而，其机制尚未完全明确。本研究评估了特定的LAA形态是否与中风相关，以及它是否与AF患者LAA的流速和大小变化有关。
对患有缺血性中风的AF患者（中风组，n = 160）和年龄匹配的无缺血性中风的AF患者（对照组，n = 200）的LAA形态、大小和流速进行评估。
与对照组相比，中风组的左心房内径更大（4.5±0.7 vs. 4.2±0.6 cm，P < 0.001），LAA开口面积更大（5.3±2.1 vs. 4.1±1.7 cm²，P < 0.001），LAA流速更慢（37±19 vs. 51±20 cm/s，P < 0.001）。中风组鸡翅型LAA的发生率低于对照组（34% vs. 50%，P = 0.003）。在对多个潜在混杂因素进行调整后，鸡翅型LAA的中风风险降低（优势比0.34，95%置信区间0.14 - 0.84，P = 0.020）。与非鸡翅型LAA患者相比，鸡翅型LAA患者的LAA开口面积更小（4.4±1.6 vs. 4.9±2.2 cm²，P = 0.013），LAA流速更高（55±19 vs. 41±20 cm/s，P < 0.001）。
鸡翅型LAA与中风发生率较低有关。我们的结果表明，特定的LAA形态与中风之间的关系可能部分由LAA的大小和流速变化来解释。
