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Eur Heart J:左心房功能可识别卒中高危的房颤患者!

2017-12-31 xing.T MedSci原创

由此可见,在CHA2DS2-VASc评分后评估超声心动图上LA储备应变和PA-TDI可以为卒中提供额外的风险分层,并对首次诊断房颤患者抗凝决策提供有用的指导。

房颤是缺血性卒中的独立危险因素。CHA2DS2-VASc评分是应用最广泛的风险分层模型;然而,超声心动图的细化可能会有帮助,特别是在低风险的房颤患者。近日,心血管领域权威杂志Eur Heart J上发表了一篇研究文章,该研究评估了高级的超声参数与缺血性卒中之间的关联,独立于CHA2DS2-VASc评分。

研究人员纳入了1361例首次诊断房颤进行了基础经胸超声心动图检查的患者(平均年龄为65±12岁,74%为男性),通过病例审查随访7.9 年,得到卒中发生率。研究人员评估了发生卒中和无卒中患者左心房(LA)体积、LA储备应变、组织多普勒成像上P波到P′持续时间(PA-TDI,反映总的心房传导时间)以及左心室(LV)整体纵向应变(GLS),并用Cox比例风险模型评价了这些超声心动图参数与缺血性卒中发生的独立关联。

一百名患者(7%)发生了缺血性中风,年卒中率为0.9%。整个人群中在首次诊断为房颤后一年内的卒中发生率为2.6%,高于随访期的其它时间。卒中患者相比于非卒中患者左心房储备(14.5% vs. 18.9%,P=0.005)和管道应变(10.5% vs. 13.5%,P=0.013)减少,而PA-TDI延长(166ms vs. 141ms,P<0.001),尽管LV的尺寸、左室射血分数、GLS和LA体积相似。左心房储备应变和PA-TDI与包含CHA2DS2-VASc评分、年龄和抗凝剂使用的模型中卒中风险独立相关。

由此可见,在CHA2DS2-VASc评分后评估超声心动图上LA储备应变和PA-TDI可以为卒中提供额外的风险分层,并对首次诊断房颤患者抗凝决策提供有用的指导。

原始出处:

Melissa Leung,et al. Left atrial function to identify patients with atrial fibrillation at high risk of stroke: new insights from a large registry. Eur Heart J.2017. https://doi.org/10.1093/eurheartj/ehx736

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    2018-01-04 虈亣靌

    学习了.涨知识了!

    0

  3. 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    2018-01-02 虈亣靌

    优质资源.共同学习

    0

  4. 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    2018-01-02 半夏微凉

    学习了谢谢分享

    0

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createdTime=Tue Jan 02 03:32:00 CST 2018, time=2018-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=274566, encodeId=6b572e456661, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/01/390f96ff34736c84fcd8848db1be40af.jpg, createdBy=958a2236299, createdName=如影随形203, createdTime=Mon Jan 01 21:53:11 CST 2018, time=2018-01-01, status=1, ipAttribution=)]
    2018-01-02 zhaojie88
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    2018-01-02 slcumt
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createdTime=Tue Jan 02 03:32:00 CST 2018, time=2018-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=274566, encodeId=6b572e456661, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/01/390f96ff34736c84fcd8848db1be40af.jpg, createdBy=958a2236299, createdName=如影随形203, createdTime=Mon Jan 01 21:53:11 CST 2018, time=2018-01-01, status=1, ipAttribution=)]
  8. 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  9. 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encodeId=56db16159865d, content=<a href='/topic/show?id=4c6a480e1f6' target=_blank style='color:#2F92EE;'>#左心房功能#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=48071, encryptionId=4c6a480e1f6, topicName=左心房功能)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ae4619715521, createdName=ms5880526374914242, createdTime=Tue Jan 02 03:32:00 CST 2018, time=2018-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1626864, encodeId=1a5d162686477, content=<a href='/topic/show?id=986a5101e46' target=_blank style='color:#2F92EE;'>#心房#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51017, encryptionId=986a5101e46, topicName=心房)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=20ba21064884, createdName=sodoo, createdTime=Tue Jan 02 03:32:00 CST 2018, time=2018-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=274566, encodeId=6b572e456661, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/01/390f96ff34736c84fcd8848db1be40af.jpg, createdBy=958a2236299, createdName=如影随形203, createdTime=Mon Jan 01 21:53:11 CST 2018, time=2018-01-01, status=1, ipAttribution=)]
    2018-01-02 sodoo
  10. 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encodeId=56db16159865d, content=<a href='/topic/show?id=4c6a480e1f6' target=_blank style='color:#2F92EE;'>#左心房功能#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=48071, encryptionId=4c6a480e1f6, topicName=左心房功能)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ae4619715521, createdName=ms5880526374914242, createdTime=Tue Jan 02 03:32:00 CST 2018, time=2018-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1626864, encodeId=1a5d162686477, content=<a href='/topic/show?id=986a5101e46' target=_blank style='color:#2F92EE;'>#心房#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51017, encryptionId=986a5101e46, topicName=心房)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=20ba21064884, createdName=sodoo, createdTime=Tue Jan 02 03:32:00 CST 2018, time=2018-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=274566, encodeId=6b572e456661, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/01/01/390f96ff34736c84fcd8848db1be40af.jpg, createdBy=958a2236299, createdName=如影随形203, createdTime=Mon Jan 01 21:53:11 CST 2018, time=2018-01-01, status=1, ipAttribution=)]
    2018-01-01 如影随形203

    不错

    0

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