EPIDEMIOLOGIC FEATURES OF ASYMPTOMATIC CEREBRAL INFARCTION IN PATIENTS WITH NONVALVULAR ATRIAL-FIBRILLATION
EPIDEMIOLOGIC FEATURES OF ASYMPTOMATIC CEREBRAL INFARCTION IN PATIENTS WITH NONVALVULAR ATRIAL-FIBRILLATION
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DOI：
10.1001/archinte.150.11.2340
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发表时间：
1990-11-01
影响因子：
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通讯作者：
PEARCE, LA
中科院分区：
文献类型：
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作者：
FEINBERG, WM;SEEGER, JF;PEARCE, LA
我们对141名无症状的非瓣膜性房颤患者进行了非增强计算机断层扫描。36例（26%）患者出现与脑梗死相符的低密度区。其中大多数为小的深部梗死，29例（21%），但13例（9%）为皮质性或大面积深部梗死。计算机断层扫描显示，12例患者有一个以上的梗死灶。年龄增长和左心房内径增加是与无症状梗死相关的唯一临床特征。年龄大于65岁且左房内径大于5.0 cm的患者（n = 23）无症状梗死发生率为52%。年龄小于65岁且左房内径小于5.0 cm的患者（n = 38）有11%的无症状梗死发生率。只有其中一种危险因素的患者（n = 72）有24%的无症状梗死发生率。与间歇性非瓣膜性心房颤动（22%）相比，慢性（34%）心房颤动患者更容易发生梗死，但这种差异并不显著。高血压、糖尿病、房颤持续时间、充血性心力衰竭、心肌梗死史和左心室功能障碍的超声心动图证据与无症状梗死无关。只有35%的小深度无症状梗死患者存在高血压病史，与无卒中患者的百分比相似。无症状性脑梗死常见于非瓣膜性房颤。与左心房增大相关，与主要脑血管危险因素缺乏相关性，提示心脏栓塞机制。需要进一步的研究来确定这些中风的功能和预后意义。
We performed unenhanced computed tomographic scans on 141 asymptomatic patients with nonvalvular atrial fibrillation. Thirty-six patients (26%) had hypodense areas consistent with cerebral infarction. The majority of these were small deep infarcts, seen in 29 patients (21%), but 13 patients (9%) had cortical or large deep infarctions. Twelve patients had more than one infarct on computed tomographic scan. Increasing age and increased left atrial diameter were the only clinical features associated with asymptomatic infarction. Patients older than 65 years with a left atrial diameter greater than 5.0 cm (n = 23) had a 52% prevalence of asymptomatic infarction. Patients younger than 65 years with a left atrial diameter less than 5.0 cm (n = 38) had an 11% prevalence of silent infarction. Patients with only one of these risk factors (n = 72) had a 24% prevalence of silent infarction. Infarction was more common in those with chronic (34%) as opposed to intermittent (22%) nonvalvular atrial fibrillation, but this difference was not significant. Hypertension, diabetes, duration of atrial fibrillation, congestive heart failure, history of myocardial infarction, and echocardiographic evidence of left ventricular dysfunction were not associated with asymptomatic infarction. A history of hypertension was present in only 35% of our patients with small-deep asymptomatic infarction, similar to the percentage in patients without stroke. Asymptomatic cerebral infarction is common in nonvalvular atrial fibrillation. The association with enlarged left atria and the lack of correlation with major cerebrovascular risk factors suggests a cardioembolic mechanism. Further study is needed to determine the functional and prognostic significance of these strokes.