Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark.
Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
Eur Heart J Cardiovasc Imaging. 2023 Apr 24;24(5):625-634. doi: 10.1093/ehjci/jead008.
To evaluate the extent of left atrial (LA) fibrosis in patients with a recent stroke without atrial fibrillation and controls without established cardiovascular disease.
This prospectively designed study used cardiac magnetic resonance to detect LA late gadolinium enhancement as a proxy for LA fibrosis. Between 2019 and 2021, we consecutively included 100 patients free of atrial fibrillation with recent ischaemic stroke (<30 days) and 50 age- and sex-matched controls. LA fibrosis assessment was achieved in 78 patients and 45 controls. Blinded to the cardiac magnetic resonance results, strokes were adjudicated according to modified Trial of Org 10172 in Acute Stroke Treatment classification as undetermined aetiology (n = 42) or as attributable to large- or small-vessel disease (n = 36). Patients with stroke had a larger extent of LA fibrosis [6.9%, interquartile range (IQR) 3.6-15.4%] than matched controls (4.2%, IQR 2.3-7.5%; P = 0.007). No differences in LA fibrosis were observed between patients with stroke of undetermined aetiology and those with large- or small-vessel disease (6.6%, IQR 3.8-16.0% vs. 6.9%, IQR 3.4-14.6%; P = 0.73).
LA fibrosis was more extensive in patients with stroke than in age- and sex-matched controls. A similar extent of LA fibrosis was observed in patients with stroke of undetermined aetiology and stroke classified as attributable to large- or small-vessel disease. Our findings suggest that LA structural abnormality is more frequent in patients with stroke than in controls independent of aetiological classification.
评估近期无房颤的脑卒中患者和无明确心血管疾病的对照组左心房（LA）纤维化的程度。
本前瞻性研究采用心脏磁共振检测 LA 晚期钆增强作为 LA 纤维化的替代指标。在 2019 年至 2021 年期间，我们连续纳入了 100 例近期缺血性脑卒中（<30 天）且无房颤的患者和 50 例年龄和性别匹配的对照组。78 例患者和 45 例对照组进行了 LA 纤维化评估。在不了解心脏磁共振结果的情况下，根据改良的组织型纤溶酶原激活物治疗急性卒中试验分类，将脑卒中判定为病因不明（n=42）或归因于大血管或小血管疾病（n=36）。脑卒中患者的 LA 纤维化程度较大（6.9%，四分位距[IQR]3.6-15.4%），明显大于匹配对照组（4.2%，IQR 2.3-7.5%；P=0.007）。病因不明的脑卒中患者与大血管或小血管疾病的脑卒中患者的 LA 纤维化程度无差异（6.6%，IQR 3.8-16.0% vs. 6.9%，IQR 3.4-14.6%；P=0.73）。
与年龄和性别匹配的对照组相比，脑卒中患者的 LA 纤维化程度更大。病因不明的脑卒中患者和归因于大血管或小血管疾病的脑卒中患者的 LA 纤维化程度相似。我们的研究结果表明，LA 结构异常在脑卒中患者中比在对照组中更为常见，且与病因分类无关。
