冠状动脉 CTA 检查左心耳在非瓣膜性心房颤动患者心源性卒中预测价值。
Coronary CTA to Investigate Predictive Value of Left Atrial Appendage for Cardiogenic Stroke in Patients with Nonvalvular Atrial Fibrillation.
机构信息
Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006, China.
Department of Radiology, Medical Imaging Center, The Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu Province 225001, China.
出版信息
Biomed Res Int. 2020 Oct 15;2020:7351876. doi: 10.1155/2020/7351876. eCollection 2020.
PURPOSE
To investigate the predictive value of changes in LAA size and function for cardiogenic stroke (CS) in patients with NVAF by coronary CTA examination. . 179 patients with NVAF were selected and grouped according to the outbreak of acute ischemic stroke and TIA within 2 years after coronary CTA examination. Those who met the criteria for CS were selected as cases (87 patients), and those neither stroke nor TIA as controls (92 patients). LAA size of selected patients was measured and data postprocessing was performed. The differences of baseline data and LAA parameters between groups were analyzed. The impacts of BMI, hyperlipidemia, the duration of AF, the LAAOA Index, and the LAAEF on CS were assessed by binary logistic regression. The predictive abilities of LAAOA Index, LAAEF, and the combined predictor were assessed by ROC curves.
RESULTS
Proportions of BMI ≥ 25, prevalence of hyperlipidemia, duration of AF, and LAAODmax, LAAODmin, LAAOA, LAAVmax, and LAAVmin with their correction index were greater in cases than controls. The LAAEF was lower in cases than that in controls. The binary logistic regression model showed an increase in LAAOA Index ( = 0.005) and a decrease in LAAEF ( < 0.001) were independent risk factors for CS. ROC curve analysis showed that the optimal cutoff values of LAAOA Index and LAAEF to predict CS were 3.16 cm/m and 38.71%, with AUC value of 0.712 and 0.734, respectively. The LAAOA Index-LAAEF combined predictor (AUC value = 0.786) was likely superior to either LAAOA Index or LAAEF.
CONCLUSIONS
Coronary CTA can provide additional valuable parameters, as a by-product of coronary artery assessment without additional radiation dose, for the risk assessment of CS in patients with NVAF. Coronary CTA may make up for the limitation of single indicator of CHADS-VASc in guiding anticoagulation program, to reduce the incidence of embolism and bleeding events.
目的
通过冠状动脉 CTA 检查，探讨左心耳（LAA）大小和功能变化对非瓣膜性心房颤动（NVAF）患者心源性卒中（CS）的预测价值。
方法
选择 179 例接受冠状动脉 CTA 检查后 2 年内发生急性缺血性卒中和 TIA 的 NVAF 患者，根据 CS 的发生情况分为两组。符合 CS 标准的患者为病例组（87 例），未发生卒中或 TIA 的患者为对照组（92 例）。测量所选患者的 LAA 大小并进行数据后处理，分析组间基线资料和 LAA 参数的差异，采用二元 logistic 回归评估 BMI、高血脂、AF 持续时间、LAAOA 指数、LAAEF 对 CS 的影响，采用 ROC 曲线评估 LAAOA 指数、LAAEF 及联合预测因子的预测能力。
结果
病例组 BMI≥25、高血脂患病率、AF 持续时间及 LAAODmax、LAAODmin、LAAOA、LAAVmax、LAAVmin 及其校正指数的比例均高于对照组，LAAEF 低于对照组。二元 logistic 回归模型显示，LAAOA 指数（ = 0.005）增加和 LAAEF（ < 0.001）降低是 CS 的独立危险因素。ROC 曲线分析显示，LAAOA 指数和 LAAEF 预测 CS 的最佳截断值分别为 3.16cm/m 和 38.71%，AUC 值分别为 0.712 和 0.734，LAAOA 指数-LAAEF 联合预测因子（AUC 值=0.786）可能优于 LAAOA 指数或 LAAEF。
结论
冠状动脉 CTA 可以为 NVAF 患者 CS 风险评估提供附加的有价值参数，且不增加额外的辐射剂量，是冠状动脉评估的副产品。冠状动脉 CTA 可能弥补 CHADS-VASc 单一指标在指导抗凝方案中的局限性，降低栓塞和出血事件的发生率。
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