右心房与青年隐源性缺血性卒中：病例对照研究。
Right atrium and cryptogenic ischaemic stroke in the young: a case-control study.
机构信息
Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
出版信息
Open Heart. 2021 May;8(1). doi: 10.1136/openhrt-2021-001596.
BACKGROUND
Recent studies suggest left atrial (LA) dysfunction in cryptogenic stroke. We studied the dynamics of right atrium (RA) and right atrial appendage (RAA) in young adults with cryptogenic stroke. We hypothesised that bi-atrial dysfunction and blood stagnation might contribute to thrombosis formation in patients with patent foramen ovale (PFO), as deep venous thrombosis is detected only in the minority of patients.
METHODS
Thirty patients (aged 18-49) with a first-ever cryptogenic stroke and 30 age-matched and sex-matched stroke-free controls underwent cardiac magnetic resonance (CMR) imaging. An approach to estimate the RAA volume was developed, using crista terminalis and pectinate muscles as anatomical landmarks. Atrial expansion indices were calculated as (maximal volume - minimal volume) ×100%/minimal volume. Total pulmonary to systemic blood flow ratio (Qp/Qs) was based on phase contrast CMR. Right-to-left shunt (RLS) was evaluated with transoesophageal echocardiography in 29 patients and transcranial Doppler in 30 controls, moderate-to-severe RLS considered as clinically significant.
RESULTS
We found that RA and RAA volumes were similar between patients and controls. Also, RA expansion index was similar, but RAA (95.6%±21.6% vs 108.7%±25.8%, p=0.026) and LA (126.2%±28% vs 144.9%±36.3%, p=0.023) expansion indices were lower in patients compared with controls. Seven (24%) of 29 patients had an RLS compared with 1 (3%) of 30 controls (p=0.012). Among 59 study subjects, RLS was associated with lower RA (81.9%±15.9% vs 98.5%±29.5%, p=0.030), RAA (84.7%±18% vs 105.6%±24.1%, p=0.022), LA (109.8%±18.6% vs 140.1%±33.7%, p=0.017) and LAA (median 102.9% (IQR 65.6%-121.7%) vs 229.1% (151.8%-337.5%], p=0.002) expansion indices and lower Qp/Qs ratio (0.91±0.06 vs 0.98±0.07, p=0.027).
CONCLUSIONS
This study suggests bi-atrial dysfunction in young adults with cryptogenic stroke, associated with moderate-to-severe RLS. Dysfunction of the atria and atrial appendages may be an additional mechanism for PFO-related stroke.
TRIAL REGISTRATION NUMBER
NCT01934725.
背景
最近的研究表明，隐匿性卒中患者左心房（LA）功能障碍。我们研究了年轻隐匿性卒中患者右心房（RA）和右心耳（RAA）的动力学。我们假设双心房功能障碍和血液淤滞可能导致卵圆孔未闭（PFO）患者血栓形成，因为只有少数患者检测到深静脉血栓形成。
方法
30 名年龄在 18-49 岁的首发隐匿性卒中患者和 30 名年龄和性别匹配的无卒中对照组接受心脏磁共振（CMR）成像。采用心耳嵴和梳状肌作为解剖学标志，开发了一种估计 RAA 容积的方法。心房扩张指数计算为（最大容积-最小容积）×100%/最小容积。基于相位对比 CMR 计算总肺循环到体循环血流比（Qp/Qs）。29 例患者采用经食管超声心动图，30 例对照组采用经颅多普勒超声检查评估右向左分流（RLS），中重度 RLS 视为有临床意义。
结果
我们发现患者和对照组的 RA 和 RAA 容积相似。RA 扩张指数也相似，但 RAA（95.6%±21.6%比 108.7%±25.8%，p=0.026）和 LA（126.2%±28%比 144.9%±36.3%，p=0.023）扩张指数均低于对照组。29 例患者中 7 例（24%）存在 RLS，而 30 例对照组中 1 例（3%）存在 RLS（p=0.012）。在 59 名研究对象中，RLS 与较低的 RA（81.9%±15.9%比 98.5%±29.5%，p=0.030）、RAA（84.7%±18%比 105.6%±24.1%，p=0.022）、LA（109.8%±18.6%比 140.1%±33.7%，p=0.017）和 LAA（中位数 102.9%（IQR 65.6%-121.7%）比 229.1%（151.8%-337.5%]，p=0.002）扩张指数和较低的 Qp/Qs 比值（0.91±0.06 比 0.98±0.07，p=0.027）相关。
结论
这项研究表明，隐匿性卒中的年轻患者存在双心房功能障碍，与中重度 RLS 相关。心房和心耳的功能障碍可能是 PFO 相关卒中的另一个机制。
临床试验注册号
NCT01934725。
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