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Comparison of left atrial and left atrial appendage mechanics in the risk stratification of stroke in patients with atrial fibrillation
Cardiovascular Ultrasound ( IF 1.9 ) Pub Date : 2021-01-09 , DOI: 10.1186/s12947-020-00232-z
Yankai Mao 1 , Chan Yu 1 , Yuan Yang 1 , Mingming Ma 1 , Yunhe Wang 2 , Ruhong Jiang 2 , Ran Chen 1 , Bowen Zhao 1 , Chenyang Jiang 2
Affiliation  

Left atrial (LA) and left atrial appendage (LAA) dysfunction has been demonstrated to contribute to atrial fibrillation (AF)-related stroke. However, usefulness of LA and LAA mechanics has not been fully compared. We sought to investigate the association of LA and LAA mechanics with stroke and to compare their diagnostic values in the risk stratification of stroke in patients with nonvalvular AF. A total of 208 consecutive patients with AF (63.58 ± 10.37 years, 63.9% male,57.7% persistent AF) who underwent echocardiography before catheter ablation were prospectively enrolled. Speckle-tracking was used to measure LA and LAA global longitudinal strain (GLS). LA and LAA mechanical dispersions (MD) were defined as the standard deviation (SD) of time to peak positive strain corrected by the R-R interval. Patients with prior stroke/ transient ischemic attack (TIA) (n = 31) had significantly higher LA and LAA MD than those without (n = 177) (11.56 ± 4.38% vs. 8.43 ± 3.44%, 15.15 ± 5.46% vs. 10.94 ± 4.40%, both P < 0.01). In multivariable analysis, LA and LAA MD were independently associated with stroke/TIA (odds ratio, 1.18–1.29, 1.19–1.22, respectively, both P < 0.01), providing incremental values over clinical and standard echocardiographic parameters. In a subgroup analysis, LA MD was more useful than LAA MD in patients with normal LA volumes, while LAA MD was superior to LA MD in patients with LA enlargement. Higher LA and LAA mechanical dispersion are independently associated with stroke/TIA in AF patients and had incremental values over clinical and conventional echocardiographic parameters. What’s more, priorities of dispersion assessment are different depending on patients’ LA size.

中文翻译:

左心耳与左心耳力学在房颤患者脑卒中危险分层中的比较

已证明左心房 (LA) 和左心耳 (LAA) 功能障碍会导致心房颤动 (AF) 相关的中风。然而,LA 和 LAA 力学的有用性尚未得到充分比较。我们试图调查 LA 和 LAA 力学与卒中的关联,并比较它们在非瓣膜性 AF 患者卒中风险分层中的诊断价值。共有 208 名在导管消融前接受超声心动图检查的连续 AF 患者(63.58 ± 10.37 岁,63.9% 男性,57.7% 持续性 AF)被前瞻性纳入。散斑跟踪用于测量 LA 和 LAA 全局纵向应变 (GLS)。LA 和 LAA 机械离散度 (MD) 被定义为由 RR 间隔校正的正应变峰值时间的标准偏差 (SD)。既往卒中/短暂性脑缺血发作 (TIA) (n = 31) 患者的 LA 和 LAA MD 显着高于无卒中者 (n = 177) (11.56 ± 4.38% vs. 8.43 ± 3.44%, 15.15 ± 5.46% vs. 10.94) ± 4.40%,两者 P < 0.01)。在多变量分析中,LA 和 LAA MD 与卒中/TIA 独立相关(优势比分别为 1.18-1.29、1.19-1.22,均 P < 0.01),提供了超过临床和标准超声心动图参数的增量值。在亚组分析中,LA MD 在 LA 体积正常的患者中比 LAA MD 更有用,而在 LA 扩大的患者中,LAA MD 优于 LA MD。较高的 LA 和 LAA 机械离散度与 AF 患者的中风/TIA 独立相关,并且比临床和常规超声心动图参数具有增量值。更重要的是,
更新日期:2021-01-10
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