Kim Andrew T, Iwata Shinichi, Ishikawa Sera, Tamura Soichiro, Matsuo Masanori, Yoshiyama Tomotaka, Nonin Shinichi, Ito Asahiro, Izumiya Yasuhiro, Yoshiyama Minoru
Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abenoku, Osaka 545-8585, Japan.
Int J Cardiol Heart Vasc. 2021 Mar 18;33:100753. doi: 10.1016/j.ijcha.2021.100753. eCollection 2021 Apr.
Although silent brain infarction is an independent risk factor for subsequent symptomatic stroke and dementia in patients with nonvalvular atrial fibrillation, little is known regarding differences in risk factors for silent brain infarction between patients with paroxysmal and persistent nonvalvular atrial fibrillation.
This study population consisted of 190 neurologically asymptomatic patients (mean age, 64 ± 11 years) with nonvalvular atrial fibrillation (119 paroxysmal, 71 persistent) who were scheduled for catheter ablation. All patients underwent brain magnetic resonance imaging to screen for silent brain infarction prior to ablation. Transthoracic and transesophageal echocardiography was performed to screen for left atrial abnormalities (left atrial enlargement, spontaneous echo contrast, or left atrial appendage emptying velocity) and complex plaques in the aortic arch.
Silent brain infarction was detected in 50 patients (26%) [26 patients (22%) in paroxysmal vs. 24 patients (34%) in persistent, p = 0.09]. Multiple logistic regression analysis indicated that age and diabetes mellitus or chronic kidney disease (estimated glomerular filtration rate < 60 mL/min/1.73 m) were associated with silent brain infarction in patients with paroxysmal nonvalvular atrial fibrillation (p < 0.05), whereas no modifiable risk factors of silent brain infarction were observed in patients with persistent nonvalvular atrial fibrillation.
These findings suggest that intensive intervention for diabetes mellitus and renal impairment from the paroxysmal stage or ablation therapy at the time of paroxysmal stage to prevent progression to persistent nonvalvular atrial fibrillation may prevent silent brain infarction and consequently reduce the risk of future symptomatic stroke.
尽管无症状脑梗死是无瓣膜性心房颤动患者随后发生症状性卒中及痴呆的独立危险因素，但关于阵发性和持续性无瓣膜性心房颤动患者无症状脑梗死危险因素的差异知之甚少。
本研究纳入了190例计划接受导管消融术的无瓣膜性心房颤动（119例阵发性，71例持续性）且无神经系统症状的患者（平均年龄64±11岁）。所有患者在消融术前均接受脑磁共振成像检查以筛查无症状脑梗死。行经胸和经食管超声心动图检查以筛查左心房异常（左心房扩大、自发回声增强或左心耳排空速度）及主动脉弓内的复杂斑块。
50例患者（26%）检测到无症状脑梗死[阵发性组26例（22%），持续性组24例（34%），p = 0.09]。多因素logistic回归分析表明，年龄和糖尿病或慢性肾脏病（估算肾小球滤过率<60 mL/min/1.73 m²）与阵发性无瓣膜性心房颤动患者的无症状脑梗死相关（p<0.05），而持续性无瓣膜性心房颤动患者未观察到无症状脑梗死的可改变危险因素。
这些发现提示，从阵发性阶段开始对糖尿病和肾功能损害进行强化干预，或在阵发性阶段进行消融治疗以防止进展为持续性无瓣膜性心房颤动，可能预防无症状脑梗死，从而降低未来发生症状性卒中的风险。
