Hashimoto Naoto, Watanabe Tetsu, Tamura Harutoshi, Tsuchiya Hayato, Wanezaki Masahiro, Kato Shigehiko, Nishiyama Satoshi, Arimoto Takanori, Takahashi Hiroki, Shishido Tetsuro, Watanabe Masafumi
Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
Heart Vessels. 2019 Dec;34(12):1936-1943. doi: 10.1007/s00380-019-01445-7. Epub 2019 Jun 5.
Left atrial (LA) functional remodeling as well as LA structural remodeling are associated with incident LA appendage (LAA) thrombus formation. This study aimed to elucidate whether combined assessment of LA functional and structural remodeling can predict LAA dysfunction and recurrent cerebrovascular events in patients with acute ischemic stroke. We performed transthoracic and transesophageal echocardiography in 196 patients within 7 days after acute ischemic stroke. Peak systolic LA strain was evaluated using 2D speckle tracking imaging. We defined the ratio of LA peak systolic strain to LA volume index (LAVI) as the LA remodeling index (LARI). All patients were prospectively followed for recurrent cerebrovascular events. We divided patients into four groups according based on the LARI quartile. LAA dysfunction increased with decreasing LARI. In total, 52 recurrent cerebrovascular events were noted during the median follow-up period of 700 days. Patients with recurrent cerebrovascular events had lower LARI than those without recurrent events (0.50 ± 0.45 vs. 1.10 ± 0.95, P < 0.001). Kaplan-Meier analysis showed that patients with lower LARI were more susceptible to recurrent cerebrovascular events than those with higher LARI. Multivariate Cox proportional hazard regression analysis showed that LARI was an independent predictor of recurrent cerebrovascular events after adjustment for confounding factors. Net reclassification index improved with the addition of LARI to basic predictors. LARI is a novel feasible parameter for LAA dysfunction and can predict recurrent cerebrovascular events in patients with acute ischemic stroke.
左心房（LA）功能重塑以及LA结构重塑均与LA心耳（LAA）血栓形成有关。本研究旨在阐明联合评估LA功能和结构重塑是否可预测急性缺血性脑卒中患者的LAA功能障碍和复发性脑血管事件。我们对196例急性缺血性脑卒中后7天内的患者进行了经胸和经食管超声心动图检查。使用二维斑点追踪成像评估LA收缩期峰值应变。我们将LA收缩期峰值应变与LA容积指数（LAVI）的比值定义为LA重塑指数（LARI）。所有患者均前瞻性随访复发性脑血管事件。我们根据LARI四分位数将患者分为四组。LAA功能障碍随着LARI的降低而增加。在700天的中位随访期内，共记录到52例复发性脑血管事件。发生复发性脑血管事件的患者的LARI低于未发生复发性事件的患者（0.50±0.45 vs. 1.10±0.95，P<0.001）。Kaplan-Meier分析显示，LARI较低的患者比LARI较高的患者更容易发生复发性脑血管事件。多变量Cox比例风险回归分析显示，在调整混杂因素后，LARI是复发性脑血管事件的独立预测因子。在基本预测因子中加入LARI后，净重新分类指数有所改善。LARI是一种用于评估LAA功能障碍的新型可行参数，可预测急性缺血性脑卒中患者的复发性脑血管事件。
