Ma Chang Sheng, Sun Shi Kun, Wang Li, Zhou Bing Yuan, Dong Feng Lin
Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China.
Front Cardiovasc Med. 2023 Jul 6;10:1090139. doi: 10.3389/fcvm.2023.1090139. eCollection 2023.
Spontaneous echo contrast (SEC) observed in transesophageal echocardiography (TEE) is a reliable predictor of the risk of future ischemic stroke in patients with non-valvular atrial fibrillation (NVAF). Left atrial strain globally reflects atrial function, remodeling and distensibility. The left atrial appendage (LAA) is a myogenic remnant of the left atrium, which can actively relax and contract. The left atrial appendage (LAA) is an important part of releasing the pressure of the left atrium. The key role of the left atrium is to regulate the left ventricular filling pressure, act as a reservoir for pulmonary venous return during ventricular contraction, and act as a conduit, transferring blood to the Left ventricle during early ventricular diastole. The purpose of this study was to explore the relationship between left atrial function and left atrial appendage spontaneous echo contrast (LAASEC).
A retrospective study of 338 patients with non-valvular AF was conducted. Two-dimensional speckle-tracking echocardiography provided the following metrics of LA strain: LA strain during the reservoir phase (LASr), LA strain during the conduit phase (LAScd). LA or LAA has the dense SEC of more than grade 3, which is defined as mud like change or pre thrombosis.
Patients with level 3 SEC ( = 81) has lower LASr than those with lower grades of SEC ( = 257) (7.20 ± 3.70 vs. 17.48 ± 8.67, < 0.001). Multivariate logistic regression model showed that the type of atrial fibrillation (persistent∼), increased heart rate, decreased LASr were independently associated with the dense LAASEC (OR (CI 95%), 5.558 (1.618-19.09), 1.016 (1.006-1.026) 0.002, 1.224 (1.085-1.381), both < 0.01). Venn Diagram showed that lower CHADVASC2 score groups had dense SEC cases. Receiver operating characteristic (ROC) curve was used for analyzing results and selecting cut off values. The cut off point for LASr < 8.85% and CHADVASC2 score was >2 scores with sensitivity and specificity were 79% and 85%.
Lower LASr is independently associated with the dense LAASEC in NVAF and has incremental values superior to clinical scores. The decrease of LASr may be a potential non-invasive parameter for evaluating the higher risk of LAA thrombosis.
经食管超声心动图（TEE）中观察到的自发回声增强（SEC）是预测非瓣膜性心房颤动（NVAF）患者未来发生缺血性卒中风险的可靠指标。左心房应变整体反映心房功能、重塑和扩张性。左心耳（LAA）是左心房的肌性残余部分，能够主动舒张和收缩。左心耳是释放左心房压力的重要部分。左心房的关键作用是调节左心室充盈压，在心室收缩时作为肺静脉回流的储存库，并在心室舒张早期作为管道将血液输送至左心室。本研究旨在探讨左心房功能与左心耳自发回声增强（LAASEC）之间的关系。
对338例非瓣膜性房颤患者进行回顾性研究。二维斑点追踪超声心动图提供了以下左心房应变指标：储存期左心房应变（LASr）、管道期左心房应变（LAScd）。左心房或左心耳出现大于3级的密集SEC，定义为泥浆样改变或血栓前状态。
3级SEC患者（n = 81）的LASr低于SEC分级较低的患者（n = 257）（7.20±3.70 vs. 17.48±8.67，P<0.001）。多因素逻辑回归模型显示，房颤类型（持续性～）、心率增加、LASr降低与密集的LAASEC独立相关（OR（95%CI），5.558（1.618 - 19.09），1.016（1.006 - 1.026），P = 0.002，1.224（1.085 - 1.381），均P<0.01）。维恩图显示CHADVASC2评分较低的组有密集SEC病例。采用受试者操作特征（ROC）曲线分析结果并选择截断值。LASr<8.85%且CHADVASC2评分>2分的截断点，敏感性和特异性分别为79%和85%。
较低的LASr与NVAF中密集的LAASEC独立相关，且具有优于临床评分的增量价值。LASr降低可能是评估LAA血栓形成较高风险的潜在非侵入性参数。
