Mitral regurgitation reduces the risk of stroke in patients with nonrheumatic atrial fibrillation
Mitral regurgitation reduces the risk of stroke in patients with nonrheumatic atrial fibrillation
复制标题
DOI：
10.1016/s0002-8703(98)70231-5
复制
发表时间：
1998-09-01
影响因子：
4.8
通讯作者：
Shimada, K
中科院分区：
文献类型：
--
作者：
Nakagami, H;Yamamoto, K;Shimada, K
背景：明显的二尖瓣反流（MR）对左房（LA）自发性回声造影剂形成具有保护作用，而左房（LA）自发性回声造影剂形成与血栓栓塞风险增加有关。然而，MR对非风湿性心房颤动（AF）患者卒中风险的影响尚不清楚。我们研究了MR是否与非风湿性房颤患者卒中风险降低相关。方法我们对290例非风湿性房颤患者回顾性收集的资料进行了观察性分析，通过经胸超声心动图估计左房直径（LAD）和MR程度。卒中的危险因素通过多因素和多因素分析进行评估。平均随访时间为7.4年。结果在随访vp期间，68例患者发生卒中（随访vp期间每年卒中发生率3.2%）。在95例LAD≥48 mm的患者中，重度MR组（中度或重度，n = 43）卒中发生率（9%）显著低于轻度MR组（无、轻微或轻度，n = 52）卒中发生率（25%）（卡方= 3.95,p = 0.047）。从轻度到重度MR增加的相对卒中风险，对于LA大小每增加10 mm，性别和每增加10岁，分别为0.45 (95% CI， 0.20至0.97),1.06 (95% CI， 0.75至1.49),0.98 （95% CI， 0.55至1.72）和1.33 （95% CI， 1.04至1.71）。结论：在非风湿性房颤患者中，年龄是卒中风险增加的独立预测因素，MR可能对卒中有保护作用，特别是在LA增大的患者中。
Background Significant mitral regurgitation (MR) is protective against left atrial (LA) spontaneous echo contrast Formation that is associated with an increased thromboembolic risk. However, the effects of MR on the risk of stroke in patients with nonrheumatic atrial fibrillation (AF) have been unknown. We studied whether or not MR was associated with a decreased risk of stroke in patients with nonrheumatic AF.Methods We performed an observational analysis of retrospectively collected data on 290 patients with nonrheumatic AF, left atrial diameter (LAD) and the degree of MR were estimated by transthoracic echocardiography. Risk factors for stroke were assessed by multivariate and multivariate analyses. The mean follow-up was 7.4 years.Results Among these patients, 68 had a stroke during the follow-vp (rate of stroke per year of Follow-vp 3.2%). In 95 patients with LAD of greater than or equal to 48 mm, the incidence of stroke (9%) in the severe MR group (moderate or severe, n = 43) was significantly lower than that (25%) of the mild MR group (none, trivial, or mild; n = 52) (chi-square = 3.95, p = 0.047). The relative risk of stroke for increase in MR from mild to severe groups, For every 10 mm increment in LA size, for sex, and for every increase of 10 years of age was 0.45 (95% CI, 0.20 to 0.97), 1.06 (95% CI, 0.75 to 1.49), 0.98 (95% CI, 0.55 to 1.72), and 1.33 (95% CI, 1.04 to 1.71), respectively.Conclusions In patients with nonrheumatic AF, age was an independent predictor of an increased risk of stroke, and MR may be protective against stroke, especially in those patients with LA enlargement.