Song Ziliang, Xu Kai, Hu Xiaofeng, Jiang Weifeng, Wu Shaohui, Qin Mu, Liu Xu
Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.
Front Cardiovasc Med. 2020 Nov 5;7:604795. doi: 10.3389/fcvm.2020.604795. eCollection 2020.
We attempted to develop more precisely quantified risk models for predicting cardiogenic stroke risk in non-valvular atrial fibrillation (NVAF) patients. We conducted a case-control study, using data from hospitalized patients with AF who underwent transesophageal echocardiography at Shanghai Chest Hospital. A total of 233 high cardiogenic stroke risk patients with left atrial appendage thrombus (LAT) or left atrial spontaneous echo contrast (LA-SEC) and 233 controls matched for age, sex, AF type. AF history, LA diameter enlargement, larger left ventricular end diastolic diameter, lower ejection fraction, greater serum uric acid (SUA), and brain natriuretic peptide (BNP) levels showed association with high stroke risk. The multivariate logistic regression analysis revealed that AF duration, left atrial diameter (LAd), left ventricular ejection fraction (LVEF), SUA, and BNP were independent risk factors of the LAT/LA-SEC. We used LAd, LVEF, SUA, and BNP to construct a combined predictive model for high stroke risk in NVAF patients (the area under ROC curve: 0.784; sensitivity 66.1%; specificity 76.8%; 95% CI 0.744-0.825, < 0.001). Comprehensive evaluation of LAd, LVEF, SUA, and BNP may help stratify the cardiogenic stroke risk among non-valvular AF patients, guiding anticoagulation therapy.
我们试图开发更精确量化的风险模型，以预测非瓣膜性心房颤动（NVAF）患者的心源性卒中风险。我们进行了一项病例对照研究，使用了在上海胸科医院接受经食管超声心动图检查的房颤住院患者的数据。共有233例具有高心源性卒中风险的患者，伴有左心耳血栓（LAT）或左心房自发显影（LA-SEC），以及233例年龄、性别、房颤类型相匹配的对照。房颤病史、左心房直径增大、左心室舒张末期直径更大、射血分数降低、血清尿酸（SUA）升高以及脑钠肽（BNP）水平与高卒中风险相关。多因素逻辑回归分析显示，房颤持续时间、左心房直径（LAd）、左心室射血分数（LVEF）、SUA和BNP是LAT/LA-SEC的独立危险因素。我们使用LAd、LVEF、SUA和BNP构建了一个NVAF患者高卒中风险的联合预测模型（ROC曲线下面积：0.784；敏感性66.1%；特异性76.8%；95%CI 0.744-0.825，<0.001）。综合评估LAd.LVEF、SUA和BNP可能有助于对非瓣膜性房颤患者的心源性卒中风险进行分层，指导抗凝治疗。
