Department of Neurology Amsterdam UMC, Location University of Amsterdam Amsterdam The Netherlands.
Department of Cardiology Amsterdam UMC, Location University of Amsterdam Amsterdam The Netherlands.
J Am Heart Assoc. 2024 Sep 3;13(17):e034106. doi: 10.1161/JAHA.123.034106. Epub 2024 Aug 27.
Left atrial appendage (LAA) slow-flow may increase the risk of ischemic stroke. We studied LAA attenuation on cardiac computed tomography in patients with acute ischemic stroke.
We used data from a prospective cohort of patients with acute ischemic stroke undergoing cardiac computed tomography during the acute stroke imaging protocol. We compared characteristics, functional outcome (modified Rankin scale: higher scores indicating worse outcome), stroke recurrence and major adverse cardiovascular events after 2-year follow-up between patients with LAA thrombus (filling defect<100 Hounsfield Unit (HU)), slow-flow (filling defect ≥100 HU) and normal filling. Of 421 patients, 31 (7%) had LAA thrombus, 69 (16%) slow-flow, and 321 (76%) normal filling. Patients with thrombus or slow-flow more often had known atrial fibrillation compared with normal filling (45%, 39%, and 9%, <0.001). Patients with thrombus had higher National Institutes of Health Stroke Scale-scores compared with slow-flow and normal filling (18 [interquartile range, 9-22], 6 [interquartile range, 3-17], and 5 [interquartile range, 2-11], <0.001). Compared with normal filling, there was no difference with slow-flow in functional outcome (median modified Rankin scale, 3 versus 2; acOR 0.8 [95% CI, 0.5-1.4]), stroke recurrence (adjusted hazard ratio, 0.8 [95% CI, 0.3-1.9]) or major adverse cardiovascular events (adjusted hazard ratio, 1.2 [95% CI, 0.7-2.1]), while patients with thrombus had worse functional outcome (median modified Rankin scale, 6, acOR, 3.3 [95% CI, 1.5-7.4]). In cryptogenic stroke patients (n=156) slow-flow was associated with stroke recurrence (27% versus 6%, aHR, 4.1 [95% CI, 1.1-15.7]).
Patients with slow-flow had similar characteristics to patients with thrombus, but had less severe strokes. Slow-flow was not significantly associated with functional outcome or major adverse cardiovascular events, but was associated with recurrent stroke in patients with cryptogenic stroke.
左心耳（LAA）缓慢血流可能会增加缺血性卒中的风险。我们研究了急性缺血性卒中患者心脏计算机断层扫描（CT）中的 LAA 衰减。
我们使用了一项前瞻性队列研究的数据，该研究纳入了在急性卒中影像方案中接受心脏 CT 的急性缺血性卒中患者。我们比较了 LAA 血栓（充盈缺损<100 亨氏单位（HU））、缓慢血流（充盈缺损≥100 HU）和正常充盈患者的特征、功能结局（改良 Rankin 量表：得分越高表示结局越差）、卒中复发和 2 年随访后的主要不良心血管事件。在 421 例患者中，31 例（7%）有 LAA 血栓，69 例（16%）有缓慢血流，321 例（76%）有正常充盈。与正常充盈相比，有血栓或缓慢血流的患者更常伴有已知的心房颤动（45%、39%和 9%，<0.001）。与缓慢血流和正常充盈相比，有血栓的患者 NIHSS 评分更高（18 [四分位距，9-22]、6 [四分位距，3-17]和 5 [四分位距，2-11]，<0.001）。与正常充盈相比，缓慢血流与功能结局（中位数改良 Rankin 量表，3 与 2；校正比值比，0.8 [95%置信区间，0.5-1.4]）、卒中复发（调整后的危险比，0.8 [95%置信区间，0.3-1.9]）或主要不良心血管事件（调整后的危险比，1.2 [95%置信区间，0.7-2.1]）无差异，而有血栓的患者功能结局更差（中位数改良 Rankin 量表，6，校正比值比，3.3 [95%置信区间，1.5-7.4]）。在隐源性卒中患者（n=156）中，缓慢血流与卒中复发相关（27%与 6%，aHR，4.1 [95%置信区间，1.1-15.7]）。
缓慢血流患者的特征与血栓患者相似，但卒中更轻。缓慢血流与功能结局或主要不良心血管事件无显著相关性，但与隐源性卒中患者的复发性卒中相关。
