Tabak Carine, Smith Ross, Bajaj Matthew, Baghdadi Sarah, Parikh Riya, Enders Robert, Uhlich Cody, Gupta Amulya, Morgan Ethan, Baer Jacob, Harvey Christopher J, Jiwani Sania, Bapat Ashutosh, Gupta Kamal, Wiley Mark A, Dendi Raghuveer, Sheldon Seth H, Reddy Madhu, Noheria Amit
The University of Kansas School of Medicine, Kansas City, Kansas.
Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, Kansas.
Heart Rhythm. 2025 Apr;22(4):923-931. doi: 10.1016/j.hrthm.2024.09.065. Epub 2024 Oct 5.
Atrial fibrillation (AF) leads to impaired left atrial appendage contractility, increasing the risk of thromboembolic stroke. The left atrial appendage emptying velocity (LAAev) measured on transesophageal echocardiogram (TEE) is a marker of increased thromboembolic risk.
The purpose of this study was to evaluate predictors of reduced LAAev for identifying individuals at increased risk for cardioembolic stroke.
This was a single-center retrospective review of TEEs and clinical charts. Predictors of LAAev <30 cm/s were identified using logistic regression. A risk prediction model was created using stepwise selection in a derivation set (n = 695) and separately tested in a validated set (n = 300).
We included TEEs on 995 patients (age 71.3±12.7 years; female 38.1%; history of AF 82.1%; in AF at evaluation 27.7%; CHADS-VASc score 4.1 ± 1.9; LAAev 41.6 ± 21.0 cm/s). Significant multivariable predictors of LAAev <30 cm/s in derivation set were used to create the CHIRPM score containing 8 variables: Coronary artery disease (1), congestive Heart failure (1), Increased left atrial volume index ≥42 mL/m (1), current Rhythm AF (1), Paroxysmal AF (2), Persistent AF (3), longstanding Persistent/permanent AF (4), and greater than moderate Mitral regurgitation (-1). In the validation set, as compared to intermediate scores (3-4), those with low scores (≤2) and high scores (≥5) had odds ratios for LAAev <30 cm/s of 0.41 (0.21, 0.78, P = .007) and 2.58 (95% confidence interval 1.45-4.61, P = .001), respectively.
We developed and validated a novel risk stratification system to predict reduced LAAev using clinical and echocardiographic variables. This may help refine the stratification of cardioembolic stroke risk.
心房颤动（AF）会导致左心耳收缩功能受损，增加血栓栓塞性中风的风险。经食管超声心动图（TEE）测量的左心耳排空速度（LAAev）是血栓栓塞风险增加的一个指标。
本研究的目的是评估LAAev降低的预测因素，以识别心源性栓塞性中风风险增加的个体。
这是一项对TEE检查和临床病历的单中心回顾性研究。使用逻辑回归确定LAAev<30 cm/s的预测因素。在一个推导集（n = 695）中使用逐步选择创建一个风险预测模型，并在一个验证集（n = 300）中单独进行测试。
我们纳入了995例患者的TEE检查结果（年龄71.3±12.7岁；女性38.1%；房颤病史82.1%；评估时处于房颤状态27.7%；CHADS-VASc评分4.1±1.9；LAAev 41.6±21.0 cm/s）。推导集中LAAev<30 cm/s的显著多变量预测因素被用于创建包含8个变量的CHIRPM评分：冠状动脉疾病（1分）、充血性心力衰竭（1分）、左心房容积指数增加≥42 mL/m（1分）、当前节律性房颤（1分）、阵发性房颤（2分）、持续性房颤（3分）、长期持续性/永久性房颤（4分）以及中重度以上二尖瓣反流（-1分）。在验证集中，与中等评分（3-4分）相比，低评分（≤2分）和高评分（≥5分）患者LAAev<30 cm/s的比值比分别为0.41（0.21, 0.78, P = .007）和2.58（95%置信区间1.45-4.61, P = .001）。
我们开发并验证了一种新的风险分层系统，使用临床和超声心动图变量来预测LAAev降低。这可能有助于完善心源性栓塞性中风风险的分层。
