Gatti Pianca Eduardo, da Rosa Luiz Gustavo Bravosi, Barcellos Pedro Tregnago, Martins Sheila Cristina Ouriques, Foppa Murilo, Pimentel Maurício, Santos Angela Barreto Santiago
Cardiology Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, RS, Brazil; Post-Graduate Program in Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Cardiology Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, RS, Brazil.
J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105066. doi: 10.1016/j.jstrokecerebrovasdis.2020.105066. Epub 2020 Jun 25.
The role of atrial fibrillation in cryptogenic stroke (CS) is well known. However, the usefulness of left atrial (LA) electrical and morphological abnormalities to identify more disabling strokes in sinus rhythm patients is less studied. We evaluated the association between electrocardiographic P-wave abnormalities and echocardiographic LA measures with neurological disability in patients with cryptogenic stroke.
In a retrospective cohort, we included all consecutive hospitalized patients with cryptogenic stroke. Patients were classified according to modified Rankin scale at hospital discharge and at 3 months. LA abnormalities were identified by electrocardiographic (ECG) P-wave, axis and LA enlargement criteria, and by bidimensional echocardiograph through left atrial diameter and volume index.
Among the 143 patients with CS (63.4 ± 14.2 years, 53% women), 70 patients were classified as non-disabling stroke (Rankin score < 2) and 73 patients as disabling stroke (Rankin score ≥ 2) at hospital discharge. On echocardiogram, more patients with disabling stroke presented with enlarged LA volume index (48% vs. 25%; p = 0.01). This difference remained significant after adjustment for age, gender, CHADS-VASc and NIHSS scores (p = 0.02) and even when the LA volume index was analyzed as a continuous variable (p = 0.055). Also, enlarged LA volume index was more prevalent (52% vs. 25%; p = 0.03) among those with disabling stroke at 3 months after hospital discharge. Among ECG criteria, only the LA enlargement assessed by downward deflection was more prevalent in disabling stroke.
Our study demonstrated an association between left atrial enlargement, assessed by downward deflection from ECG and volume index from echocardiogram, and more disabling cryptogenic strokes. This information could help to identify patients with poorer prognosis, or a subgroup where atrial cardiopathy may play a role in cardioembolic pathway.
心房颤动在隐源性卒中（CS）中的作用已广为人知。然而，左心房（LA）电活动和形态异常对识别窦性心律患者中更致残性卒中的有用性研究较少。我们评估了隐源性卒中患者心电图P波异常及超声心动图LA测量值与神经功能残疾之间的关联。
在一项回顾性队列研究中，我们纳入了所有连续住院的隐源性卒中患者。根据出院时及3个月时的改良Rankin量表对患者进行分类。通过心电图（ECG）P波、电轴和LA扩大标准以及二维超声心动图通过左心房直径和容积指数来识别LA异常。
在143例CS患者（63.4±14.2岁，53%为女性）中，70例患者出院时被分类为非致残性卒中（Rankin评分<2），73例患者为致残性卒中（Rankin评分≥2）。在超声心动图检查中，更多致残性卒中患者表现为LA容积指数增大（48%对25%；p=0.01）。在调整年龄、性别、CHADS-VASc和NIHSS评分后，这种差异仍然显著（p=0.02），甚至当将LA容积指数作为连续变量分析时也是如此（p=0.055）。此外，出院后3个月时，致残性卒中患者中LA容积指数增大更为普遍（52%对25%；p=0.03）。在心电图标准中，仅通过向下偏移评估的LA扩大在致残性卒中中更为普遍。
我们的研究表明，通过心电图向下偏移和超声心动图容积指数评估的左心房扩大与更致残性的隐源性卒中之间存在关联。这一信息有助于识别预后较差的患者，或心房心肌病可能在心脏栓塞途径中起作用的亚组。
