Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
Department of Ultrasound Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
EuroIntervention. 2023 Oct 23;19(8):695-702. doi: 10.4244/EIJ-D-23-00325.
The current risk stratification schemes for stroke in patients with atrial fibrillation (AF) are insufficient for an accurate assessment of stroke risk.
This study evaluates the association between the mechanical function of the left atrial appendage (LAA), as assessed by angiography, and the risk of stroke.
We conducted a cross-sectional study to assess the mechanical function of the LAA by measuring the left atrial appendage ejection fraction (LAAEF) and grading the contrast retention (CR) using angiography.
A total of 746 patients referred for a left atrial appendage occlusion (LAAO) procedure with (n=151; stroke group) or without (n=595; control group) a history of stroke were included in the analysis. LAAEF was significantly lower (14% [9-19] vs 20% [12-33]; p<0.001) and grade 3 CR was more common (66.9% vs 33.9%; p<0.001) in patients with a history of stroke. Multivariable analysis showed that CR was independently associated with stroke in patients with AF (grade 2 vs grade 1=7.29; 95% confidence interval [CI]: 2.84-21.65; p<0.001; grade 3 vs grade 1=16.45; 95% CI: 6.16-51.02; p<0.001). The receiver operating characteristics curve demonstrated that CR identified patients with stroke more accurately than the CHAD-VASc score (C-statistic 0.712 vs 0.512; p<0.001), and the combination of CR and the CHADS-VASc score provided the best performance (C-statistic 0.871 vs 0.829 [CHADS-VASc score alone]; p=0.048) Conclusions: Impaired mechanical function of the LAA, indicated by a low LAAEF and CR, is associated with a history of stroke in patients with AF. Assessment of CR using LAA angiography helps improve the stratification scheme for stroke risk prediction.
目前用于房颤患者中风风险分层的方案对于准确评估中风风险还不够。
本研究通过评估左心耳（LAA）的机械功能与中风风险之间的关系来评估 LAA 的机械功能。
我们进行了一项横断面研究，通过测量左心耳射血分数（LAAEF）和造影剂保留分级（CR）来评估 LAA 的机械功能。
共纳入 746 例因左心耳封堵术（LAAO）而就诊的患者（n=151；中风组）或无中风病史（n=595；对照组）。中风组 LAAEF 明显较低（14%[9-19] vs 20%[12-33]；p<0.001），且 3 级 CR 更为常见（66.9% vs 33.9%；p<0.001）。多变量分析显示，CR 在 AF 患者中与中风独立相关（2 级 vs 1 级=7.29；95%可信区间[CI]：2.84-21.65；p<0.001；3 级 vs 1 级=16.45；95% CI：6.16-51.02；p<0.001）。ROC 曲线表明，CR 比 CHAD-VASc 评分更能准确识别中风患者（C 统计量 0.712 与 0.512；p<0.001），而 CR 与 CHADS-VASc 评分的联合应用提供了最佳性能（C 统计量 0.871 与 0.829[CHADS-VASc 评分单独使用]；p=0.048）。结论：LAA 机械功能受损，表现为 LAAEF 降低和 CR，与 AF 患者的中风病史有关。LAA 血管造影评估 CR 有助于改善中风风险预测的分层方案。
