隐源性卒中、左心房功能与心房颤动：一种复杂的关系。

Cryptogenic stroke, left atrial function, and atrial fibrillation: a complex relationship.

作者信息

Gabrielli Francesca Augusta, Bencardino Gianluigi, Renzo Antonio Di, Abruzzese Serena, Colò Francesca, Festa Pasquale Alessandro, Severo Lorenzo, Ballacci Federico, Lanza Gaetano Antonio, Lombardo Antonella, Pelargonio Gemma, Broccolini Aldobrando

机构信息

Cardiology Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Cardiology Department, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, Milan, Italy.

出版信息

Clin Res Cardiol. 2025 Sep 2. doi: 10.1007/s00392-025-02743-z.

DOI:10.1007/s00392-025-02743-z

PMID:40892065

Abstract

BACKGROUND

Paroxysmal atrial fibrillation (AF) may underlie some embolic strokes of undetermined source (ESUS), but the widespread use of loop recorders (LRs) to detect it may not be cost-effective. This study evaluated whether assessing left atrial (LA) function by speckle tracking echocardiography (STE) could help to identify ESUS patients most likely to benefit from LR monitoring for AF detection.

METHODS

Consecutive ESUS patients diagnosed between 2020 and 2023, who underwent LR implantation and comprehensive echocardiographic evaluation, including STE, were enrolled. Patients were divided into two groups based on AF detection by LR over a median follow-up of 10.0 months (IQR 6.0-21.7).

RESULTS

A total of 64 patients were included: 27 (42.2%) with AF (AF group) and 37 (57.8%) without AF (No-AF group). Compared to the No-AF group, patients in the AF group showed a significantly larger left atrial volume index (LAVi: 44.7 ± 10.8 vs. 34.4 ± 8.3 mL/m; p < 0.001), a lower LA longitudinal strain of reservoir (LASr: 19.7 ± 8.9% vs. 27.4 ± 9.5%; p = 0.003) and contraction (LASct: 7.4 ± 6.5% vs. 12.4 ± 7.2%; p = 0.008), and an increased LA stiffness index (LASi: 0.6 ± 0.3 vs. 0.3 ± 0.2; p < 0.001). In multivariable Cox regression analysis, only LAVi and LASct remained independent predictors of AF.

CONCLUSIONS

LAVi and LASct appear useful and reliable predictors of AF occurrence during follow-up in ESUS patients and may aid in selecting those who are most likely to benefit from LR implantation.

摘要

背景

阵发性心房颤动（AF）可能是某些不明来源栓塞性卒中（ESUS）的潜在病因，但广泛使用环路记录仪（LR）来检测AF可能不具有成本效益。本研究评估了通过斑点追踪超声心动图（STE）评估左心房（LA）功能是否有助于识别最有可能从LR监测中受益以检测AF的ESUS患者。

方法

纳入2020年至2023年间连续诊断的ESUS患者，这些患者接受了LR植入及包括STE在内的全面超声心动图评估。根据LR在中位随访10.0个月（四分位间距6.0 - 21.7）期间检测到的AF情况，将患者分为两组。

结果

共纳入64例患者：27例（42.2%）有AF（AF组），37例（57.8%）无AF（非AF组）。与非AF组相比，AF组患者的左心房容积指数显著更大（LAVi：44.7±10.8 vs. 34.4±8.3 mL/m²；p < 0.001），心房储存期纵向应变（LASr：19.7±8.9% vs. 27.4±9.5%；p = 0.003）和收缩期纵向应变（LASct：7.4±6.5% vs. 12.4±7.2%；p = 0.008）更低，心房僵硬度指数更高（LASi：0.6±0.3 vs. 0.3±0.2；p < 0.001）。在多变量Cox回归分析中，只有LAVi和LASct仍然是AF的独立预测因素。