Tsao Hsuan-Ming, Hu Wei-Chih, Tsai Ping-Huang, Lee Chao-Lin, Wang Hsueh-Han, Chang Shih-Lin, Chao Tze-Fan, Chen Shih-Ann
Division of Cardiology, National Yang Ming University Hospital, Yi-Lan.
Department of Biomedical Engineering, Chung-Yuan Christian University, Chungli.
Acta Cardiol Sin. 2017 Jan;33(1):50-57. doi: 10.6515/acs20160411a.
It is critical to recognize high risk patients who are prone to develop stroke in the management of atrial fibrillation (AF). The purpose of this study was to identify the determinants of AF related stroke by assessing the anatomical and functional remodeling of cardiac chambers.
We compared the cardiac structure and function of 28 consecutive patients with paroxysmal and persistent AF-related stroke with 69 patients with AF and 21 controls without stroke using contrast-enhanced 64-slice multi-detector computed tomography during sinus rhythm.
The volume of left atrium (LA), LA appendage (LAA) and right atrium (RA) were significantly increased across the groups with sinus rhythm (SR), AF and AF-related stroke (p < 0.001 for each, respectively). The emptying fraction and booster-pump function of LA, LAA and RA were decreased across the groups (p < 0.001 for each). In addition, the left ventricular mass index was increased in AF related stroke (p = 0.003). Using multivariate analysis, increased age (p = 0.003), reduced booster-pump function of LA (p = 0.01), LAA (p < 0.001) and RA (p < 0.001) were shown to be independently associated with the occurrence of stroke.
The dilatation and contractile dysfunction of both atria are related to the development of stroke in patients with paroxysmal and persistent AF. Our results suggested that the use of substrate-based assessment may help improve risk stratification of stroke in patients with AF.
在心房颤动（AF）的管理中，识别易发生中风的高危患者至关重要。本研究的目的是通过评估心腔的解剖和功能重塑来确定AF相关中风的决定因素。
我们在窦性心律期间使用对比增强64层多探测器计算机断层扫描，比较了28例阵发性和持续性AF相关中风患者、69例AF患者和21例无中风对照者的心脏结构和功能。
在窦性心律（SR）、AF和AF相关中风组中，左心房（LA）、左心耳（LAA）和右心房（RA）的容积均显著增加（每组p均<0.001）。LA、LAA和RA的排空分数和辅助泵功能在各组中均降低（每组p<0.001）。此外，AF相关中风患者的左心室质量指数增加（p = 0.003）。多变量分析显示，年龄增加（p = 0.003）、LA（p = 0.01）、LAA（p<0.001）和RA（p<0.001）的辅助泵功能降低与中风的发生独立相关。
阵发性和持续性AF患者的双房扩张和收缩功能障碍与中风的发生有关。我们的结果表明，基于基质的评估可能有助于改善AF患者中风的风险分层。
