CTA上左心耳血栓与功能转归的临床关联。
The clinical association of left atrial appendage thrombus on CTA with functional outcome.
作者信息
Winders Joel, Di Bartolo Angelo, Kim Jamin, Wilson Duncan, Senadeera Sajith, Alamri Yassar, Fink John, Beharry James, Parsons Mark W, Levi Christopher, Spratt Neil, Chew Beng Lim Alvin, Hasnain Md Golam, Miteff Ferdinand, Rinkel Leon, Nio Shan Sui, Al-Hadethi Sinan, Lim Anthony, Coutinho Jonathan, Garcia-Esperon Carlos, Wu Teddy Y, Berry-Noronha Alexander
机构信息
Department of Neurology, Christchurch Hospital, Christchurch, New Zealand.
Department of Radiology, Christchurch Hospital, Christchurch, New Zealand.
出版信息
Eur Stroke J. 2025 Sep 26:23969873251377215. doi: 10.1177/23969873251377215.
BACKGROUND
Left atrial appendage (LAA) thrombus is associated with atrial fibrillation (AF) and can be a marker of atrial cardiomyopathy. We determined the association between computed tomography angiography (CTA) identified LAA thrombus in patients presenting with acute ischaemic stroke or transient ischaemic attack (TIA), and 3-month outcome.
METHODS
We undertook a dual-centre, retrospective cohort study from New Zealand and Australia. All consecutive patients presenting with acute ischaemic stroke or TIA during the inclusion period who underwent acute stroke imaging were included. We analysed the association with CTA-LAA thrombus and 3-month outcome on modified Rankin Scale using multivariable logistic regression models adjusted for known predictors of outcome.
RESULTS
Of the 1435 patients included, 1304 (90.9%) had acute ischaemic stroke and 131 (9.1%) had TIA. 582 (41%) had confirmed intracranial medium or large vessel occlusion (MLVO), and 565 (40%) received reperfusion therapies. CTA-LAA thrombus was identified in 58 (4.0%) patients, and these patients were older (median age 85 (IQR 75-88) vs 73 (63-81), < 0.01), more likely to be female (62% vs 40%, < 0.01), had higher rates of AF (79% vs 29%, < 0.01), heart failure (29% vs 9%, < 0.01), MLVO (53% vs 40%, = 0.05), and mortality at 3-months (28% vs 11%, < 0.01). Adjusting for known predictors of poor outcome, LAA thrombus was independently associated with increased 3-month mRS score (OR: 2.02, 95% CI: 1.20-3.40, < 0.01).
CONCLUSIONS
CTA-LAA thrombus detected during the acute stroke imaging protocol in patients with ischemic stroke or TIA is a predictor of worse outcome.
背景
左心耳（LAA）血栓与心房颤动（AF）相关，并且可能是心房心肌病的一个标志物。我们确定了在急性缺血性卒中或短暂性脑缺血发作（TIA）患者中通过计算机断层血管造影（CTA）识别出的LAA血栓与3个月预后之间的关联。
方法
我们开展了一项来自新西兰和澳大利亚的双中心回顾性队列研究。纳入了在纳入期内所有因急性缺血性卒中或TIA就诊且接受了急性卒中影像学检查的连续患者。我们使用针对已知预后预测因素进行调整的多变量逻辑回归模型，分析了CTA-LAA血栓与改良Rankin量表评估的3个月预后之间的关联。
结果
在纳入的1435例患者中，1304例（90.9%）为急性缺血性卒中，131例（9.1%）为TIA。582例（41%）确诊为颅内中或大血管闭塞（MLVO），565例（40%）接受了再灌注治疗。58例（4.0%）患者通过CTA发现LAA血栓，这些患者年龄更大（中位年龄85岁（四分位间距75 - 88岁）对比73岁（63 - 81岁），P < 0.01），更可能为女性（62%对比40%，P < 0.01），AF发生率更高（79%对比29%，P < 0.01），心力衰竭发生率更高（29%对比9%，P < 0.01），MLVO发生率更高（53%对比40%，P = 0.05），3个月死亡率更高（28%对比11%，P < 0.01）。在对已知的不良预后预测因素进行调整后，LAA血栓与3个月改良Rankin量表评分增加独立相关（比值比：2.02，95%置信区间：1.20 - 3.40，P < 0.01）。
结论
在缺血性卒中或TIA患者的急性卒中影像学检查过程中检测到的CTA-LAA血栓是预后较差的一个预测因素。
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