Ameriso S F, Sager P, Fisher M
Department of Neurology University of Southern California School of Medicine Los Angeles, CA.
Department of Medicine (Cardiology) University of Southern California School of Medicine.
J Neuroimaging. 1992 Oct;2(4):190-4. doi: 10.1111/jon199224190.
Atrial fibrillation and congestive heart failure are risk factors for ischemic stroke usually attributed to cardiac embolism. To define potential alternative mechanisms, patients with atrial fibrillation and congestive heart failure were investigated by transcranial Doppler. Middle cerebral artery (MCA) blood flow velocities were analyzed in neurologically asymptomatic patients with nonvalvular (n = 10) and valvular (n = 13) atrial fibrillation, patients in normal sinus rhythm with congestive heart failure (n = 13), and control subjects (n = 11). Compared to patients in sinus rhythm with congestive heart failure and to control subjects, patients in both atrial fibrillation groups had significantly greater beat-to-beat variation in peak, mean, and diastolic velocities and in pulsatility index. Peak, mean, and diastolic MCA velocities in patients with atrial fibrillation and those with congestive heart failure were significantly less than those in control subjects. Patients with nonvalvular atrial fibrillation had a higher pulsatility index compared to each of the other three groups. These findings demonstrate substantial nonemboligenic alterations of the intracranial circulation associated with atrial fibrillation and congestive heart failure, and also provide an intracranial hemodynamic profile that may distinguish valvular from nonvalvular atrial fibrillation.
心房颤动和充血性心力衰竭是通常归因于心脏栓塞的缺血性卒中的危险因素。为了确定潜在的其他机制，采用经颅多普勒对心房颤动和充血性心力衰竭患者进行了研究。分析了无神经症状的非瓣膜性心房颤动患者（n = 10）、瓣膜性心房颤动患者（n = 13）、窦性心律伴充血性心力衰竭患者（n = 13）以及对照受试者（n = 11）的大脑中动脉（MCA）血流速度。与窦性心律伴充血性心力衰竭患者和对照受试者相比，两个心房颤动组患者的峰值、平均和舒张期速度以及搏动指数的逐搏变化均显著更大。心房颤动患者和充血性心力衰竭患者的MCA峰值、平均和舒张期速度显著低于对照受试者。与其他三组中的每一组相比，非瓣膜性心房颤动患者的搏动指数更高。这些发现表明与心房颤动和充血性心力衰竭相关的颅内循环存在大量非栓塞性改变，并且还提供了一种可能区分瓣膜性心房颤动和非瓣膜性心房颤动的颅内血流动力学特征。
