Paciaroni Maurizio, Agnelli Giancarlo, Falocci Nicola, Caso Valeria, Becattini Cecilia, Marcheselli Simona, Rueckert Christina, Pezzini Alessandro, Poli Loris, Padovani Alessandro, Csiba Laszló, Szabó Lilla, Sohn Sung-Il, Tassinari Tiziana, Abdul-Rahim Azmil H, Michel Patrik, Cordier Maria, Vanacker Peter, Remillard Suzette, Alberti Andrea, Venti Michele, Acciarresi Monica, D'Amore Cataldo, Mosconi Maria Giulia, Scoditti Umberto, Denti Licia, Orlandi Giovanni, Chiti Alberto, Gialdini Gino, Bovi Paolo, Carletti Monica, Rigatelli Alberto, Putaala Jukka, Tatlisumak Turgut, Masotti Luca, Lorenzini Gianni, Tassi Rossana, Guideri Francesca, Martini Giuseppe, Tsivgoulis Georgios, Vadikolias Kostantinos, Liantinioti Chrissoula, Corea Francesco, Del Sette Massimo, Ageno Walter, De Lodovici Maria Luisa, Bono Giorgio, Baldi Antonio, D'Anna Sebastiano, Sacco Simona, Carolei Antonio, Tiseo Cindy, Imberti Davide, Zabzuni Dorjan, Doronin Boris, Volodina Vera, Consoli Domenico, Galati Franco, Pieroni Alessio, Toni Danilo, Monaco Serena, Baronello Mario Maimone, Barlinn Kristian, Pallesen Lars-Peder, Kepplinger Jessica, Bodechtel Ulf, Gerber Johannes, Deleu Dirk, Melikyan Gayane, Ibrahim Faisal, Akhtar Naveed, Lees Kennedy R
Stroke Unit and Division of Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Via G. Dottori 1, 06100, Perugia, Italy.
Neurologia d'urgenza e Stroke Unit, Istituto Clinico Humanitas, Rozzano, Milan, Italy.
J Neurol. 2016 Feb;263(2):231-237. doi: 10.1007/s00415-015-7957-3. Epub 2015 Nov 14.
Anticoagulant therapy is recommended for the secondary prevention of stroke in patients with atrial fibrillation (AF). T he identification of patients at high risk for early recurrence, which are potential candidates to prompt anticoagulation, is crucial to justify the risk of bleeding associated with early anticoagulant treatment. The aim of this study was to evaluate in patients with acute ischemic stroke and AF the association between findings at trans-thoracic echocardiography (TTE) and 90 days recurrence. In consecutive patients with acute ischemic stroke and AF, TTE was performed within 7 days from hospital admission. Study outcomes were recurrent ischemic cerebrovascular events (stroke or TIA) and systemic embolism. 854 patients (mean age 76.3 ± 9.5 years) underwent a TTE evaluation; 63 patients (7.4%) had at least a study outcome event. Left atrial thrombosis was present in 11 patients (1.3%) among whom 1 had recurrent ischemic event. Left atrial enlargement was present in 548 patients (64.2%) among whom 51 (9.3%) had recurrent ischemic events. The recurrence rate in the 197 patients with severe left atrial enlargement was 11.7%. On multivariate analysis, the presence of atrial enlargement (OR 2.13; 95% CI 1.06-4.29, p = 0.033) and CHA2DS2-VASc score (OR 1.22; 95% CI 1.04-1.45, p = 0.018, for each point increase) were correlated with ischemic recurrences. In patients with AF-associated acute stroke, left atrial enlargement is an independent marker of recurrent stroke and systemic embolism. The risk of recurrence is accounted for by severe atrial enlargement. TTE-detected left atrial thrombosis is relatively uncommon.
抗凝治疗推荐用于心房颤动（AF）患者的卒中二级预防。识别具有早期复发高风险的患者（这些患者是早期抗凝的潜在候选者）对于证明早期抗凝治疗相关出血风险的合理性至关重要。本研究的目的是评估急性缺血性卒中和AF患者经胸超声心动图（TTE）检查结果与90天复发之间的关联。在连续的急性缺血性卒中和AF患者中，于入院后7天内进行TTE检查。研究结局为复发性缺血性脑血管事件（卒中或短暂性脑缺血发作）和全身性栓塞。854例患者（平均年龄76.3±9.5岁）接受了TTE评估；63例患者（7.4%）至少发生了一项研究结局事件。11例患者（1.3%）存在左心房血栓形成，其中1例发生复发性缺血事件。548例患者（64.2%）存在左心房扩大，其中51例（9.3%）发生复发性缺血事件。197例严重左心房扩大患者的复发率为11.7%。多因素分析显示，心房扩大（比值比2.13；95%可信区间1.06 - 4.29，p = 0.033）和CHA2DS2 - VASc评分（每增加1分，比值比1.22；95%可信区间1.04 - 1.45，p = 0.018）与缺血性复发相关。在AF相关急性卒中患者中，左心房扩大是复发性卒中和全身性栓塞的独立标志物。严重心房扩大导致复发风险增加。TTE检测到的左心房血栓形成相对少见。
