Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center.
Department of Cardiology, Saitama Medical University International Medical Center.
J Nippon Med Sch. 2024;91(3):322-327. doi: 10.1272/jnms.JNMS.2024_91-311.
The differences in the characteristics of ischemic stroke associated with a mobile versus nonmobile residual left atrial thrombus (LAT) are unclear. We investigated whether the mobility of an LAT detected by transthoracic echocardiography is associated with the clinical features of stroke.
This study included 20 consecutive patients with nonvalvular atrial fibrillation who were admitted to our hospital for treatment of acute ischemic stroke and then found to have an LAT on transthoracic echocardiography. The patients were divided into two groups: those with a mobile LAT (Group M) and those with a nonmobile LAT (Group N). The clinical, neuroradiological, and echocardiographic variables were assessed.
The LAT was mobile in 11 patients (Group M) and nonmobile in nine patients (Group N). The median National Institutes of Health Stroke Scale score on admission was higher in Group M than N (17 vs. 7, respectively; p=0.196). Four patients in Group M and one in Group N developed in-hospital stroke recurrence (36% vs. 11%, respectively; p=0.319). The prevalence of large vessel occlusion (15 events in Group M and 10 events in Group N, including in-hospital recurrent events) was significantly higher in Group M than N (73% vs. 30%, respectively; p=0.049), which seemed to lead to poorer functional outcomes in Group M than N (ratio of modified Rankin scale score of 0-2 at discharge: 18% vs. 44%, respectively; p=0.336).
The mobility of LAT may affect stroke severity in patients with nonvalvular atrial fibrillation.
与可移动或不可移动的左心房血栓（LAT）相关的缺血性脑卒中的特征差异尚不清楚。我们研究了经胸超声心动图检测到的 LAT 的活动性是否与脑卒中的临床特征相关。
本研究纳入了 20 例连续的因急性缺血性脑卒中入院且经经胸超声心动图发现 LAT 的非瓣膜性心房颤动患者。患者被分为两组：LAT 可移动组（M 组）和 LAT 不可移动组（N 组）。评估了临床、神经影像学和超声心动图变量。
11 例患者的 LAT 可移动（M 组），9 例患者的 LAT 不可移动（N 组）。M 组入院时的美国国立卫生研究院卒中量表评分中位数高于 N 组（分别为 17 分和 7 分；p=0.196）。M 组中有 4 例患者和 N 组中有 1 例患者发生院内卒中复发（分别为 36%和 11%；p=0.319）。M 组的大血管闭塞（M 组中有 15 例事件，N 组中有 10 例事件，包括院内复发事件）发生率明显高于 N 组（73%和 30%；p=0.049），这似乎导致 M 组的功能结局比 N 组差（出院时改良 Rankin 量表评分 0-2 的比例：分别为 18%和 44%；p=0.336）。
LAT 的活动性可能会影响非瓣膜性心房颤动患者的卒中严重程度。
