Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore.
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Cerebrovasc Dis. 2020;49(3):285-291. doi: 10.1159/000508211. Epub 2020 Jun 17.
It is unclear which surrogate of atrial cardiopathy best predicts the risk of developing a recurrent ischemic stroke in embolic stroke of undetermined source (ESUS). Left atrial diameter (LAD) and LAD index (LADi) are often used as markers of left atrial enlargement in current ESUS research, but left atrial volume index (LAVi) has been found to be a better predictor of cardiovascular outcomes in other patient populations.
We aim to compare the performance of LAVi, LAD, and LADi in predicting the development of new-onset atrial fibrillation (AF) and stroke recurrence in ESUS.
Between October 2014 and October 2017, consecutive patients diagnosed with ESUS were followed for new-onset AF, ischemic stroke recurrence, and a composite outcome of occult AF and stroke recurrence. LAVi and LADi were measured by transthoracic echocardiogram; "high" LAVi was defined as ≥35 mL/m2 in accordance with American Society of Echocardiography guidelines.
185 ischemic stroke patients with ESUS were recruited and followed for a median duration of 2.1 years. Increased LAVi was associated with new-onset AF detection (aOR 1.08; 95% CI 1.03-1.14; p = 0.003) and stroke recurrence (aOR 1.05; 95% CI 1.01-1.10; p = 0.026). Patients with "high" LAVi had a higher likelihood of developing a composite of AF detection and stroke recurrence (HR 3.45; 95% CI 1.55-7.67; p = 0.002). No significant association was observed between LADi and either occult AF or stroke recurrence.
LAVi is associated with new-onset AF and stroke recurrence in ESUS patients and may be a better surrogate of atrial cardiopathy.
在不明来源栓塞性卒中（ESUS）中，哪种心房心肌病的替代指标能最好地预测复发性缺血性卒中的风险尚不清楚。左心房直径（LAD）和左心房指数（LADi）常用于当前 ESUS 研究中的左心房扩大标志物，但在其他患者人群中，左心房容积指数（LAVi）已被发现是心血管结局的更好预测指标。
我们旨在比较 LAVi、LAD 和 LADi 在预测 ESUS 中新发心房颤动（AF）和卒中复发的表现。
在 2014 年 10 月至 2017 年 10 月期间，连续入组诊断为 ESUS 的患者，随访新发 AF、缺血性卒中复发和隐匿性 AF 和卒中复发的复合终点事件。通过经胸超声心动图测量 LAVi 和 LADi；根据美国超声心动图学会指南，将“高”LAVi 定义为≥35 mL/m2。
共纳入 185 例 ESUS 缺血性卒中患者，中位随访时间为 2.1 年。升高的 LAVi 与新发 AF 检出（优势比 1.08；95%置信区间 1.03-1.14；p = 0.003）和卒中复发（优势比 1.05；95%置信区间 1.01-1.10；p = 0.026）相关。LAVi 较高的患者发生 AF 检出和卒中复发复合终点的可能性更高（风险比 3.45；95%置信区间 1.55-7.67；p = 0.002）。LADi 与隐匿性 AF 或卒中复发之间无显著相关性。
LAVi 与 ESUS 患者新发 AF 和卒中复发相关，可能是心房心肌病的更好替代指标。
