Atrial cardiopathy: a broadened concept of left atrial thromboembolism beyond atrial fibrillation.
Atrial cardiopathy: a broadened concept of left atrial thromboembolism beyond atrial fibrillation.
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DOI：
10.2217/fca.15.22
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发表时间：
2015-05
影响因子：
1.7
通讯作者：
Soliman EZ
中科院分区：
文献类型：
--
作者：
Kamel H;Okin PM;Longstreth WT Jr;Elkind MS;Soliman EZ
长期以来，房颤（AF）与缺血性卒中和全身性血栓栓塞的风险增加有关，但最近的数据需要重新评估我们对这种关系性质的理解。关于房颤和卒中之间的时间联系的新发现，以及在没有明显房颤的情况下将左心房异常标志物与卒中联系起来的证据表明，即使没有房颤，左心房血栓栓塞也可能发生。这些观察结果破坏了定义房颤的心律失常是必要且足以导致血栓栓塞的假设。在这篇评论中，我们反而认为血栓栓塞的基质可能往往是与AF相关的解剖和生理心房紊乱。因此，如果我们将其起源从AF转移到心房性心脏病的概念，我们对心源性栓塞性卒中的理解可能会更完整。
Atrial fibrillation (AF) has long been associated with a heightened risk of ischemic stroke and systemic thromboembolism, but recent data require a re-evaluation of our understanding of the nature of this relationship. New findings about the temporal connection between AF and stroke, alongside evidence linking markers of left atrial abnormalities with stroke in the absence of apparent AF, suggest that left atrial thromboembolism may occur even without AF. These observations undermine the hypothesis that the dysrhythmia that defines AF is necessary and sufficient to cause thromboembolism. In this commentary, we instead suggest that the substrate for thromboembolism may often be the anatomic and physiological atrial derangements associated with AF. Therefore, our understanding of cardioembolic stroke may be more complete if we shift our representation of its origin from AF to the concept of atrial cardiopathy.