Echocardiographic Risk Assessment to Guide Screening for Atrial Fibrillation
Echocardiographic Risk Assessment to Guide Screening for Atrial Fibrillation
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DOI：
10.1016/j.echo.2019.07.003
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发表时间：
2019-10-01
影响因子：
6.5
通讯作者：
Marwick, Thomas H.
中科院分区：
文献类型：
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作者：
Ramkumar, Satish;Ochi, Ayame;Marwick, Thomas H.
背景：尽管房颤(房颤)是一个重要的人群健康负担，也是中风的一个可避免的原因，但房颤的筛查仍然存在争议。本研究的目的是探讨偶合超声心动图是否能提供房颤高危患者的信息。方法：对年龄65岁、有超过一个房颤危险因素(N=445)的无症状受试者进行了中位数15个月的房颤事件跟踪调查。测量左房容量指数(Lavi)、左心室(LV)整体纵向应变(GLS；绝对值)、左房(LA)应变和左心室质量。在随访期间，由初级保健医生或使用单导联便携式心电监测设备(参与者在一周内进行了5次60秒记录)临床诊断为房颤。结果：45例患者诊断为房颤(10%；平均年龄70.5+/-4.2岁；55%女性)。左心室肥厚、GLS及Lt；16%、Lavi及Lt；34m L/m(2)及LA储藏菌株及Lt；34%的房颤检出率较高。GLS、LAVI和LA储层应变与房颤独立相关(P<；0.05)。房颤患者的GLS降低，Lavi增加，LV质量增加(P<；0.05)，但两组LA应变相似(P>；0.05)。GLS和LAVI是最强的预测因子，GLS和LAVI的切点分别为14.3%和39mL/m(2)与发生房颤的风险增加相关。所有四个危险参数(LV肥厚、GLS和Lt；16%、LA储藏应变和Lt；34%和Lavi&Gt；34m L/m(2))的房颤发现率为60%，而没有这些特征的患者为7%(P=0.004)。结论：超声心动图广泛应用于房颤高危患者，简单的LV和LA测量可以丰富房颤的筛查过程。
Background:Although atrial fibrillation (AF) is a significant population health burden, and an avoidable cause of stroke, AF screening remains controversial. The aim of this study was to investigate whether coincidental echocardiography could provide information about patients at risk for AF.Methods: Asymptomatic participants >= 65 years of age with more than one AF risk factor (N = 445) undergoing echocardiography for risk evaluation were followed over a median of 15 months for incident AF. Left atrial volume index (LAVi), left ventricular (LV) global longitudinal strain (GLS; absolute value), left atrial (LA) strain, and LV mass were measured. During the follow-up period, AF was diagnosed clinically by primary care physicians or by using a single-lead portable electrocardiographic monitoring device (five 60-sec recordings performed by participants over 1 week).Results: AF was diagnosed in 45 patients (10%; mean age, 70.5 +/- 4.2 years; 55% women). AF detection was higher in those with LV hypertrophy, GLS < 16%, LAVi > 34 mL/m(2), and LA reservoir strain < 34%. GLS, LAVi, and LA reservoir strain were independently associated with AF (P < .05). Those with AF had reduced GLS, higher LAVi, and higher LV mass (P < .05), but LA strain was similar in both groups (P > .05). GLS and LAVi were the strongest predictors, and cut points of 14.3% for GLS and 39 mL/m(2) were associated with increased risk for developing AF. Those with all four risk parameters (LV hypertrophy, GLS < 16%, LA reservoir strain < 34%, and LAVi > 34 mL/m(2)) had a 60% AF detection rate, compared with 7% without these features (P = .004).Conclusion: Echocardiography is widely used in patients at risk for AF, and simple LV and LA measurements may be used to enrich the process of AF screening.