Sanchis Laura, Montserrat Silvia, Obach Víctor, Cervera Álvaro, Chamorro Ángel, Vidal Bàrbara, Mas-Stachurska Aleksandra, Bijnens Bart, Sitges Marta
Departamento de Cardiología, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Spain.
Departamento de Cardiología, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Spain.
Rev Esp Cardiol (Engl Ed). 2016 Jul;69(7):650-6. doi: 10.1016/j.rec.2015.11.033. Epub 2016 Mar 3.
Stroke etiology remains undetermined in up to 30% of cases. Paroxysmal atrial fibrillation is found in 20% to 28% of patients with stroke initially classified as being of undetermined etiology. The aim of our study was to analyze left atrial function in ischemic stroke patients to identify patterns associated with cardioembolic etiology and to determine whether the patterns identified can be found in individuals initially classified as having a stroke of undetermined etiology.
We studied a cohort of in-hospital ischemic stroke patients referred for transthoracic echocardiography. Treating neurologists determined stroke etiology based on the TOAST classification. Left atrial contractile function was assessed using 2-dimensional echocardiography to determine their ejection fraction and speckle tracking to measure left atrial strain rate: a-wave. Left atrial function was compared between stroke etiology subgroups and healthy controls.
Ninety-seven patients (aged 67±15 years) with ischemic stroke (16.5% large-artery atherosclerosis, 15.5% small-vessel occlusion, 11.3% cardioembolic, 5.1% other determined etiology, 51.1% undetermined etiology) and 10 healthy volunteers (aged 63±7 years) were included. Left atrial ejection fraction was significantly decreased only in patients with stroke of cardioembolic and undetermined etiology compared with the control group (31.5±17.2%, 40.2±17.1%, and 59.1±8.4%, respectively; P=.004). The left atrial strain rate was significantly lower in patients with stroke caused by cardioembolic or undetermined etiology, or large-artery atherosclerosis compared with controls (-0.86±0.49, -1.31±0.56, -1.5±0.47, -2.37±1.18, respectively; P<.001).
Patients with stroke of undetermined etiology with left atrial function (ejection fraction and strain) similar to that of cardioembolic stroke patients may be misclassified and could potentially benefit from prolonged electrocardiography monitoring. Left atrial function analysis (ejection fraction and strain) might help to identify potential cardioembolic sources in patients with stroke of undetermined etiology.
高达30%的卒中病例病因仍不明确。在最初被归类为病因不明的卒中患者中，20%至28%存在阵发性心房颤动。我们研究的目的是分析缺血性卒中患者的左心房功能，以确定与心源性栓塞病因相关的模式，并确定在最初被归类为病因不明的卒中患者中是否能发现所确定的模式。
我们研究了一组因经胸超声心动图检查而入院的缺血性卒中患者。治疗神经科医生根据TOAST分类确定卒中病因。使用二维超声心动图评估左心房收缩功能以确定其射血分数，并使用斑点追踪技术测量左心房应变率：a波。比较了卒中病因亚组与健康对照者的左心房功能。
纳入了97例缺血性卒中患者（年龄67±15岁）（16.5%为大动脉粥样硬化，15.5%为小血管闭塞，11.3%为心源性栓塞，5.1%为其他明确病因，51.1%为病因不明）和10名健康志愿者（年龄63±7岁）。与对照组相比，仅心源性栓塞和病因不明的卒中患者的左心房射血分数显著降低（分别为31.5±17.2%、40.2±17.1%和59.1±8.4%；P = 0.004）。与对照组相比，心源性栓塞或病因不明的卒中患者以及大动脉粥样硬化患者的左心房应变率显著降低（分别为-0.86±0.49、-1.31±0.56、-1.5±0.47、-2.37±1.18；P < 0.001）。
病因不明的卒中患者若左心房功能（射血分数和应变）与心源性栓塞性卒中患者相似，可能会被误诊，可能会从延长的心电图监测中获益。左心房功能分析（射血分数和应变）可能有助于识别病因不明的卒中患者潜在的心源性栓塞来源。
