Hosseini Farahabadi Maryam, Milani-Nejad Shadi, Liu Shimeng, Yu Wengui, Shafie Mohammad
Department of Neurology, University of California, Irvine, Irvine, CA, United States.
Department of Neurology, Beijing Tiatan Hospital, Capital Medical University, Beijing, China.
Front Neurol. 2021 Sep 13;12:680651. doi: 10.3389/fneur.2021.680651. eCollection 2021.
Left atrial (LA) dilatation and heart failure are independent risk factors for ischemic stroke. The goal of this study is to evaluate the association between LA dilatation and reduced left ventricular ejection fraction (EF) with cardioembolic stroke. Four hundred fifty-three patients with ischemic stroke admitted to the University of California, Irvine between 2016 and 2017 were included based on the following criteria: age >18 and availability of echocardiogram. Stroke was categorized into cardioembolic and non-cardioembolic. EF was categorized into normal: 52-72% (male), 54-74% (female), mildly abnormal: 41-51% (male), 41-53% (female), moderately abnormal: 30-40%, and severely abnormal: <30%. LA volume was categorized into normal (≤34 ml/m) vs. enlarged (≥35 ml/m). Other variables included gender, hypertension [systolic blood pressure (SBP) ≥ 140 or diastolic blood pressure (DBP) ≥ 90], and known history of atrial fibrillation (Afib). Two hundred eighteen patients had cardioembolic, and 235 had non-cardioembolic stroke. Among patients with cardioembolic stroke, 49 (22.4%) and 142 (65%) had reduced EF and enlarged LA, respectively, as compared with 19 (8.1%) and 65 (27.7%) patients with non-cardioembolic stroke ( < 0.0001). The odds of cardioembolic stroke were 2.0 (95% CI: 0.1-6.0) and 8.8 times (95% CI: 1.9-42.3) higher in patients with moderately and severely reduced EF, respectively, than in patients with normal EF. The odds of cardioembolic stroke was 2.4 times (95% CI: 1.5-3.9) higher in patients with enlarged LA than in patients with normal LA size. Compared with patients with normal LA and EF, patients with combined enlarged LA and reduced EF had significantly higher rates of Afib (43.4 vs. 9.0%, < 0.0001) and cardioembolic stroke (78.3 vs. 43.4%, < 0.0001). LA dilatation along with reduced EF is a reliable predictor of Afib and cardioembolic stroke. Further studies are warranted to determine the benefit of anticoagulation for secondary stroke prevention in such patient population.
左心房（LA）扩张和心力衰竭是缺血性卒中的独立危险因素。本研究的目的是评估LA扩张和左心室射血分数（EF）降低与心源性栓塞性卒中之间的关联。纳入了2016年至2017年间入住加利福尼亚大学欧文分校的453例缺血性卒中患者，纳入标准如下：年龄>18岁且有超声心动图检查结果。卒中分为心源性栓塞性和非心源性栓塞性。EF分为正常：52 - 72%（男性），54 - 74%（女性）；轻度异常：41 - 51%（男性），41 - 53%（女性）；中度异常：30 - 40%；重度异常：<30%。LA容积分为正常（≤34 ml/m）与增大（≥35 ml/m）。其他变量包括性别、高血压[收缩压（SBP）≥140或舒张压（DBP）≥90]以及房颤（Afib）病史。218例患者为心源性栓塞性卒中，235例为非心源性栓塞性卒中。在心源性栓塞性卒中患者中，分别有49例（22.4%）和142例（65%）EF降低和LA增大，而非心源性栓塞性卒中患者中分别有19例（8.1%）和65例（27.7%）（P<0.0001）。EF中度和重度降低的患者发生心源性栓塞性卒中的几率分别比EF正常的患者高2.0倍（95%CI：0.1 - 6.0）和8.8倍（95%CI：1.9 - 42.3）。LA增大的患者发生心源性栓塞性卒中的几率比LA大小正常的患者高2.4倍（95%CI：1.5 - 3.9）。与LA和EF正常的患者相比，LA增大合并EF降低的患者房颤发生率（43.4%对9.0%，P<0.0001）和心源性栓塞性卒中发生率（78.3%对43.4%，P<0.0001）显著更高。LA扩张伴EF降低是房颤和心源性栓塞性卒中的可靠预测指标。有必要进一步研究确定在此类患者群体中抗凝用于二级卒中预防中的益处。
