Left Atrial Expansion Index for Ischemic Stroke Prediction in Patients with Atrial Fibrillation.

IF 1.8 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Acta Cardiologica Sinica Pub Date : 2024-01-01 DOI:10.6515/ACS.202401_40(1).20230628A

Jau-Wen Shiau, Chao-Sheng Hsiao, Shih-Hung Hsiao

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Abstract

Background: The efficacy of the left atrial (LA) expansion index (LAEI) to predict cerebral ischemic events in patients with atrial fibrillation (AF) is unknown.

Methods: We enrolled 177 patients with AF (88 with paroxysmal AF and 89 with persistent AF) and a baseline CHA₂DS₂-VASc score (at enrollment) of 3.6 ± 2.3. Comprehensive echocardiography was performed at enrollment. The LAEI was calculated as (Vol_max - Vol_min) × 100%/Vol_min, where Vol_max and Vol_min denoted maximal and minimal LA volumes, respectively. The study endpoint was ischemic stroke. Stroke subtypes were classified into cardioembolic stroke (CE), non-CE with determined mechanism (NCE), embolic stroke of undetermined source (ESUS), or transient ischemic attack (TIA).

Results: Over a mean 9.9-year follow-up period, 44 (24.9%) of the patients reached the endpoint (24 with CE, 4 with NCE, 6 with ESUS, and 10 with TIA). The LAEI was lower in the stroke group than in the non-stroke group. Stroke incidence in the lowest LAEI quartile was much higher than that in the other LAEI quartiles; the 10-year cumulative stroke risk was 15.9% (14/88) and 33.7% (30/89) in the patients with paroxysmal and persistent AF, respectively. An LAEI of < 35% predicted the presence of stroke with 77% sensitivity and 78% specificity. In multivariable analysis, the LAEI was independently associated with ischemic stroke (hazard ratio 0.952 per 1% increase, 95% confidence interval 0.932-0.971, p < 0.0001).

Conclusions: The LAEI is a useful predictor of ischemic stroke in patients with AF.

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预测心房颤动患者缺血性卒中的左心房扩张指数

背景：左心房（LA）扩张指数（LAEI）预测心房颤动（AF）患者脑缺血事件的有效性尚不清楚：我们招募了 177 名房颤患者（88 名阵发性房颤患者和 89 名持续性房颤患者），他们的基线 CHA2DS2-VASc 评分（入组时）为 3.6 ± 2.3。入组时进行了全面的超声心动图检查。LAEI的计算公式为（Volmax - Volmin）×100%/Volmin，其中Volmax和Volmin分别表示最大和最小LA容积。研究终点为缺血性卒中。中风亚型分为心肌栓塞性中风（CE）、机制确定的非CE（NCE）、来源不明的栓塞性中风（ESUS）或短暂性脑缺血发作（TIA）：在平均 9.9 年的随访期内，44 例（24.9%）患者达到终点（24 例 CE、4 例 NCE、6 例 ESUS 和 10 例 TIA）。中风组的 LAEI 低于非中风组。LAEI 最低四分位数的卒中发生率远高于其他 LAEI 四分位数；阵发性和持续性房颤患者的 10 年累积卒中风险分别为 15.9% （14/88）和 33.7% （30/89）。LAEI < 35% 预测中风发生的敏感性为 77%，特异性为 78%。在多变量分析中，LAEI 与缺血性中风有独立相关性（每增加 1%，危险比为 0.952，95% 置信区间为 0.932-0.971，P < 0.0001）：LAEI是房颤患者缺血性卒中的有效预测指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Cardiologica Sinica 医学-心血管系统

CiteScore

2.90

自引率

15.80%

发文量

144

审稿时长

>12 weeks

期刊介绍： Acta Cardiologica Sinica welcomes all the papers in the fields related to cardiovascular medicine including basic research, vascular biology, clinical pharmacology, clinical trial, critical care medicine, coronary artery disease, interventional cardiology, arrythmia and electrophysiology, atherosclerosis, hypertension, cardiomyopathy and heart failure, valvular and structure cardiac disease, pediatric cardiology, cardiovascular surgery, and so on. We received papers from more than 20 countries and areas of the world. Currently, 40% of the papers were submitted to Acta Cardiologica Sinica from Taiwan, 20% from China, and 20% from the other countries and areas in the world. The acceptance rate for publication was around 50% in general.