Anatomical characteristics of the left atrial appendage in cardiogenic stroke with low CHADS2 scores
Anatomical characteristics of the left atrial appendage in cardiogenic stroke with low CHADS2 scores
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DOI：
10.1016/j.hrthm.2013.01.036
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发表时间：
2013-06-01
期刊：
影响因子：
5.5
通讯作者：
Fukuda, Keiichi
中科院分区：
文献类型：
--
作者：
Kimura, Takehiro;Takatsuki, Seiji;Fukuda, Keiichi
背景：即使CHADS（2）评分低的患者也会发生卒中，90%的情况下左心耳（LAA）是栓塞源。我们将LAA形态作为卒中的新预测因子。 目的阐明左心耳的解剖学特征，用于CHADS（2）评分低的非瓣膜性房颤（AF）患者卒中风险分层。 方法对80例房颤导管消融术患者进行对比增强CT检查，比较30例有脑卒中史患者和50例年龄匹配的对照组的左心耳特征。LAA解剖结构分为4种类型-“仙人掌”、“花椰菜”、“鸡翅”和“风向袋”-通过LAA的长度、角度和叶数的计算机断层扫描测量进行区分。 结果：脑卒中患者和对照组的平均CHADS 2评分无显著差异（0.8 +/- 0.8 vs 0.6 +/- 0.7; P = 0.277）。8例（26.7%）卒中患者的CHA（2）DS（2）-VASc评分为0。左心房大小、左心耳血流速度、左心室功能和血清脑钠肽水平也不能预测卒中。然而，“菜花形”左心耳（定义为主叶长度小于4 cm，无分叉叶）在卒中患者中明显更常见（比值比3.857; 95%置信区间1.482-10.037; P = .005）。CHA（2）DS（2）-VASc评分调整的logistic回归分析显示，花椰菜LAA是卒中的独立预测因子（比值比3.355; 95%置信区间1.243-9.055; P = .017）。 结论：左心耳解剖结构可能有助于预测CHADS 2评分较低的非瓣膜性房颤患者的卒中。
BACKGROUND Strokes develop even in patients with low CHADS(2) scores, and the left atrial appendage (LAA) is the embolic source 90% of the time. We focused on the LAA morphology as a new predictor of strokes. OBJECTIVE To clarify the anatomical characteristics of the LAA for risk stratification of strokes in patients with nonvalvular atrial fibrillation (AF) who have low CHADS(2) scores. METHODS Among 80 patients who underwent catheter ablation of AF with contrast-enhanced computed tomography, the LAA characteristics were compared between 30 patients with histories of strokes and 50 age-matched controls. The LAA anatomy was classified into 4 types-"cactus," "cauliflower," "chicken wing," and "windsock"-discriminated by the computed tomography measurements of the length, angle, and number of lobes of the LAA. RESULTS The average CHADS2 score did not differ significantly between patients with stroke and controls (0.8 +/- 0.8 vs 0.6 +/- 0.7; P = .277). Eight (26.7%) patients with stroke had CHA(2)DS(2)-VASc scores of 0. The left atrial size, LAA flow velocity, left ventricular function, and serum brain natriuretic peptide level were also unable to predict strokes. However, a "cauliflower" LAA, defined as a main lobe of less than 4 cm long without forked lobes, was significantly more common in patients with stroke (odds ratio 3.857; 95% confidence interval 1.482-10.037; P = .005). The CHA(2)DS(2)-VASc score-adjusted logistic regression analysis revealed the cauliflower LAA as an independent predictor of a stroke (odds ratio 3.355; 95% confidence interval 1.243-9.055; P = .017). CONCLUSIONS The LAA anatomy might be useful for predicting strokes in patients with nonvalvular AF who have low CHADS2 scores.