Xue Jie, Xu Xu-Shen, Zhu Xiao-Qiong, Li Zhi-Zhang, Zhang Xiao-Guang, Ma Yan-Ting, Yang Wen-Hao, Liu Ling-Yun, Yue Yun-Hua
Department of Neurology, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Neurology, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China.
J Stroke Cerebrovasc Dis. 2020 May;29(5):104767. doi: 10.1016/j.jstrokecerebrovasdis.2020.104767. Epub 2020 Mar 12.
Left atrial enlargement is associated with increased risk for stroke. However, few studies that evaluated the correlation between left atrial size and ischemic stroke severity. In this study, we aim to evaluate the association between left atrial size and stroke severity, especially with cardioembolic and cryptogenic stroke in the Chinese population.
A total of 1271 patients with acute ischemic stroke were included in this study. Echocardiographic left atrial diameter was measured and indexed to height. Stroke severity was assessed at admission with the National Institutes of Health Stroke Scale (NIHSS). Moderate-to-severe neurologic deficit was defined as NIHSS greater than or equal to 5. Patients were divided into mild, moderate, or severe abnormal left atrial size by tertile distribution. Binary logistic regression analysis was used to identify independent predictors of severe stroke after adjustment.
Among all enrolled patients, 328 (25.8%) were classified into moderate-to severe stroke severity (NIHSS ≥ 5). In the multivariable model, compared with the lowest tertile of left atrial size, the odds ratio for moderate-to-severe neurologic deficit was 0.902 (95% CI, 0.644-1.264, P = .550) when left atrial size was the highest tertile. Of all patients, 190 patients were further categorized as cardioembolic and cryptogenic subtypes, and 70 (36.8%) were classified into moderate-to-severe stroke severity. After adjusting for confounders, compared with the lowest tertile, the top tertile of left atrial size was significantly associated with moderate-to-severe stroke (3.156, 95% CI, 1.143-8.711, P = .027).
Left atrial enlargement was associated with more severe initial neurologic deficits of embolic subtypes (cardioembolic and cryptogenic stroke) in patients with acute ischemic stroke.
左心房扩大与中风风险增加相关。然而，很少有研究评估左心房大小与缺血性中风严重程度之间的相关性。在本研究中，我们旨在评估中国人群中左心房大小与中风严重程度之间的关联，特别是与心源性栓塞性中风和隐源性中风的关联。
本研究共纳入1271例急性缺血性中风患者。测量超声心动图左心房直径并根据身高进行指数化。入院时使用美国国立卫生研究院卒中量表（NIHSS）评估中风严重程度。中度至重度神经功能缺损定义为NIHSS大于或等于5。患者按三分位数分布分为左心房大小轻度、中度或重度异常。采用二元逻辑回归分析确定调整后严重中风的独立预测因素。
在所有纳入的患者中，328例（25.8%）被归类为中度至重度中风严重程度（NIHSS≥5）。在多变量模型中，与左心房大小最低三分位数相比，当左心房大小为最高三分位数时，中度至重度神经功能缺损的比值比为0.902（95%CI，0.644-1.264，P = 0.550）。在所有患者中，190例患者进一步分为心源性栓塞性和隐源性亚型，70例（36.8%）被归类为中度至重度中风严重程度。在调整混杂因素后，与最低三分位数相比，左心房大小最高三分位数与中度至重度中风显著相关（3.156，95%CI，1.143-8.711，P = 0.027）。
左心房扩大与急性缺血性中风患者栓塞性亚型（心源性栓塞性和隐源性中风）更严重的初始神经功能缺损相关。
