左心耳形态作为心房颤动患者卒中风险评估的决定因素：系统评价与荟萃分析
Left Atrial Appendage Morphology as a Determinant for Stroke Risk Assessment in Atrial Fibrillation Patients: Systematic Review and Meta-Analysis.
作者信息
Anan Abu Rmilah, Fareed Jumah, Suhaib Jaber, Rafat Roubi, Murad Daana, Isam Bsisu, Tariq Muamar, Patricia Erwin, Alexander Egbe, Vaidya Vaibha, Peter A Noseworthy, Abhishek Deshmukh
机构信息
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Rutgers-Robert Wood Johnson Universty Hospital, New Brunswick, NJ, USA.
出版信息
J Atr Fibrillation. 2019 Aug 31;12(2):2183. doi: 10.4022/jafib.2183. eCollection 2019 Aug-Sep.
BACKGROUND
Atrial fibrillation (AF) is a leading source of emboli that precipitate cerebrovascular accident (CVA) which is correlated with left atrial appendage (LAA) morphology. We aimed to elaborate the relationship between CVA and LAA morphology in AF patients.
METHODS
Medline and EMBASE databases were thoroughly searched between 2010-2018 for studies that included atrial fibrillation patients and classified them into two groups based on CVA occurrence. Four different LAA morphologies (Chicken wing CW, Cauliflower, cactus and windsock) were determined in each group by 3D TEE, MDCT or CMRI. New Castle Ottawa Scale was used to appraise the quality of included studies. The risk of CVA before cardiac ablation and/or LAA intervention in CW patients was compared to each type of non-CW morphologies. The extracted data was statistically analyzed in the form of forest plot by measuring the risk ratio (RR) using REVMAN software. P value and I square were used to assess the heterogeneity between studies.
RESULTS
PRISMA diagram was illustrated showing 789 imported studies for screening. Three duplicates were removed, and the rest were arbitrated by 2 reviewers yielding 12 included studies with 3486 patients including 1551 with CW, 442 with cauliflower, 732 with cactus 765 with windsock. The risk of CVA in CW patients was reduced by 41% relative to non-CW patients (Total RR=0.59 (0.52-0.68)). Likewise, the risk of CVA in CW patients was less by 46%, 35% and 31% compared to cauliflower (Total RR =0.54(0.46-0.64)), cactus (Total RR =0.65(0.55-0.77)) and windsock (Total RR =0.69(0.58-0.83)) patients respectively. Low levels of heterogeneity were achieved in all comparisons (I square <35% and p value > 0.1).
CONCLUSIONS
Patients with non-CW morphologies (cauliflower, cactus and windsock) show a higher incidence of CVA than CW patients. For that reason, LAA appendage morphology could be useful for risk stratification of CVA in AF patients.
背景
心房颤动（AF）是引发脑血管意外（CVA）的主要栓子来源，这与左心耳（LAA）形态相关。我们旨在阐述房颤患者中CVA与LAA形态之间的关系。
方法
全面检索2010年至2018年期间的Medline和EMBASE数据库，查找纳入心房颤动患者的研究，并根据CVA的发生情况将他们分为两组。通过三维经食管超声心动图（3D TEE）、多层螺旋CT（MDCT）或心脏磁共振成像（CMRI）确定每组中四种不同的LAA形态（鸡翅形（CW）、花椰菜形、仙人掌形和风向袋形）。使用纽卡斯尔渥太华量表评估纳入研究的质量。比较CW患者在心脏消融和/或LAA干预前发生CVA的风险与每种非CW形态的风险。使用REVMAN软件通过测量风险比（RR），以森林图的形式对提取的数据进行统计分析。P值和I²用于评估研究之间的异质性。
结果
展示PRISMA流程图，显示有789项导入研究用于筛选。去除三项重复研究，其余由两名评审员进行仲裁，最终纳入12项研究，共3486例患者，其中1551例为CW形态，442例为花椰菜形，732例为仙人掌形，765例为风向袋形。与非CW患者相比，CW患者发生CVA的风险降低了41%（总RR = 0.59（0.52 - 0.68））。同样，与花椰菜形患者（总RR = 0.54（0.46 - 0.64））、仙人掌形患者（总RR = 0.65（0.55 - 0.77））和风向袋形患者（总RR = 0.69（0.58 - 0.83））相比，CW患者发生CVA的风险分别降低了46%、35%和31%。所有比较中的异质性水平均较低（I² < 35%且p值 > 0.1）。
结论
非CW形态（花椰菜形、仙人掌形和风向袋形）的患者发生CVA的发生率高于CW患者。因此，LAA形态可用于房颤患者CVA的风险分层。
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