Relationship between left atrial volume and ischemic stroke subtype
Relationship between left atrial volume and ischemic stroke subtype
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DOI：
10.1002/acn3.50841
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发表时间：
2019-07-26
影响因子：
5.3
通讯作者：
Kim, Jiwon
中科院分区：
文献类型：
--
作者：
Kamel, Hooman;Okin, Peter M.;Kim, Jiwon
目的不伴心房颤动（AF）的心房性心脏病可能是不明原因栓塞性卒中（ESUS）的潜在心脏源。心房容积是心房性心脏病的一个特征，但心房容积与ESUS之间的关系尚不清楚。方法我们比较了康奈尔大学急性卒中学术注册中心（CAESAR）中缺血性卒中亚型的左心房容积，该注册中心包括自2011年以来我院所有急性缺血性卒中患者。卒中亚型由神经科医生根据吐司分类和共识ESUS定义确定。直接从我们的超声心动图图像系统（Xcelera，Philips Healthcare）获得左心房容积指数（LAVI）。我们使用t检验和方差分析进行未调整的比较，并针对人口统计学和合并症调整的比较进行基于目标最小损失的估计。结果2011 - 2016年CAESAR的2116例患者中，1293例进行了LAVI测量。各亚型的LAVI差异显著（P < 0.001），心源性卒中为48.8（+/- 30.0）mL/m2，小血管卒中为30.3（+/- 10.5）mL/m2。ESUS的LAVI（33.3 +/- 13.6 mL/m2）大于小血管或大血管卒中的LAVI（30.9 +/- 10.7 mL/m2）（P = 0.01）。在调整人口统计学和合并症后，LAVI和ESUS之间的相关性仍然存在：LAVI增加10 mL/m2与ESUS概率增加4.4%相关（95% CI，2.3%-6.4%）。在出院后心律监测期间排除AF患者后，结果相似。我们发现ESUS患者的左心房比非心源性栓塞性卒中患者的左心房大。ESUS和非心源性栓塞性卒中之间的左心房大小存在显著重叠，突出表明许多ESUS病例不是心源性栓塞。
Objective Atrial cardiopathy without atrial fibrillation (AF) may be a potential cardiac source of embolic strokes of undetermined source (ESUS). Atrial volume is a feature of atrial cardiopathy, but the relationship between atrial volume and ESUS remains unclear. Methods We compared left atrial volume among ischemic stroke subtypes in the Cornell Acute Stroke Academic Registry (CAESAR), which includes all patients with acute ischemic stroke at our hospital since 2011. Stroke subtype was determined by neurologists per the TOAST classification and consensus ESUS definition. Left atrial volume index (LAVI) was obtained directly from our echocardiography image system (Xcelera, Philips Healthcare). We used t-tests and analysis of variance for unadjusted comparisons and targeted minimum loss-based estimation for comparisons adjusted for demographics and comorbidities. Results Among 2116 patients in CAESAR from 2011 to 2016, 1293 had LAVI measurements. LAVI varied across subtypes (P < 0.001) from 48.8 (+/- 30.0) mL/m(2) in cardioembolic strokes to 30.3 (+/- 10.5) mL/m(2) in small-vessel strokes. LAVI was larger in ESUS (33.3 +/- 13.6 mL/m(2)) than in small- or large-vessel stroke (30.9 +/- 10.7 mL/m(2)) (P = 0.01). The association between LAVI and ESUS persisted after the adjustment for demographics and comorbidities: a 10 mL/m(2) increase in LAVI was associated with a 4.4% increase in ESUS probability (95% CI, 2.3%-6.4%). Results were similar after excluding patients with AF during post-discharge heart-rhythm monitoring. Interpretation We found larger left atria among patients with ESUS versus non-cardioembolic stroke. There was significant overlap in left atrial size between ESUS and non-cardioembolic stroke, highlighting that many ESUS cases are not cardioembolic.