Yoshida S, Fukuda M
Department of Ultrasound & Medical Diagnosis, Sapporo Medical College.
Rinsho Byori. 1993 Mar;41(3):273-8.
Cerebral embolism is one of the major complications of atrial fibrillation (Af). We studied patients with Af, retrospectively, as to the factors related to cerebral embolism. We examined 82 cases with transthoracic echocardiography (TTE) and trans-esophageal echocardiography (TEE) as well as ambulatory (Holter) ECG and 12 leads ECG. Thirty-three patients had cerebral ischemic attack (CIA), including 14 patients with mitral stenosis (MS) and 19 patients with other heart disease or lone Af (NonMS). The CIA group of NonMS were older than other groups. Both the CIA and NonCIA groups had the same frequency of paroxysmal and chronic Af. In the CIA group, there was a tendency of small amplitude of f wave and longer RR interval than the NonCIA group with ambulatory ECG. The CIA group also had larger left atrial cavity size and aortic diameter with TTE. TEE revealed thrombus formation in 29 cases, and the CIA group had a higher occurrence rate of thrombus than NonCIA group. TEE also detected a fuzzy echo in the left atrium in 88% of the CIA group and 42% of the NonCIA group. The risk factors of cerebral embolism could not be made clear in this study, but a fuzzy echo and thrombus in the left atrium with TEE are specific findings of cerebral embolism. Therefore, older patients with paroxysmal Af, large LAD, AOD, small f wave or long RR interval need to be examined by TEE to detect LA thrombus or a fuzzy echo, which are probably major risk factors of cerebral embolism.
脑栓塞是心房颤动（Af）的主要并发症之一。我们对Af患者进行了回顾性研究，以探讨与脑栓塞相关的因素。我们对82例患者进行了经胸超声心动图（TTE）、经食管超声心动图（TEE）检查，以及动态心电图（Holter）和12导联心电图检查。33例患者发生了脑缺血发作（CIA），其中14例患有二尖瓣狭窄（MS），19例患有其他心脏病或孤立性Af（非MS）。非MS组的CIA患者比其他组年龄更大。CIA组和非CIA组阵发性和慢性Af的发生率相同。在动态心电图检查中，CIA组的f波振幅较小且RR间期较长，与非CIA组相比有这种趋势。通过TTE检查，CIA组的左心房腔大小和主动脉直径也更大。TEE显示29例有血栓形成，CIA组的血栓发生率高于非CIA组。TEE还在88%的CIA组和42%的非CIA组中检测到左心房内有模糊回声。本研究未能明确脑栓塞的危险因素，但TEE显示左心房内有模糊回声和血栓是脑栓塞的特异性表现。因此，对于阵发性Af、左心房内径（LAD）大、主动脉内径（AOD）大、f波小或RR间期长的老年患者，需要进行TEE检查以检测左心房血栓或模糊回声，这些可能是脑栓塞的主要危险因素。
