背景:左心耳(LAA)慢血流可能会增加缺血性卒中的风险。我们研究了急性缺血性卒中患者心脏计算机断层扫描的LAA衰减。
结果:我们使用了在急性卒中成像方案期间接受心脏计算机断层扫描的急性缺血性卒中患者的前瞻性队列数据。我们比较了特点,功能结果(改良的Rankin量表:分数越高,表明结果越差),LAA血栓(充盈缺陷<100Hounsfield单位(HU))患者在2年随访后的卒中复发和主要不良心血管事件,缓慢流动(充填缺陷≥100HU)和正常充填。421名患者中,31(7%)有左心耳血栓,69(16%)慢流量,和321(76%)正常填充。与正常充盈相比,有血栓或慢血流的患者更经常有已知的心房颤动(45%,39%,9%,P<0.001)。与缓慢流动和正常充盈相比,血栓患者的美国国立卫生研究院卒中量表评分更高(18[四分位距,9-22],6[四分位数范围,3-17],和5[四分位数范围,2-11],P<0.001)。与正常灌装相比,缓慢流动在功能结局上没有差异(中位数改良Rankin量表,3对2;acOR为0.8[95%CI,0.5-1.4]),中风复发(调整后的风险比,0.8[95%CI,0.3-1.9])或主要不良心血管事件(调整后的风险比,1.2[95%CI,0.7-2.1]),而血栓患者的功能预后较差(中位改良Rankin量表,6,阿科,3.3[95%CI,1.5-7.4])。在隐源性卒中患者(n=156)中,慢血流与卒中复发相关(27%对6%,aHR,4.1[95%CI,1.1-15.7])。
结论:慢血流患者具有与血栓患者相似的特征,但中风不那么严重。慢血流与功能结局或主要不良心血管事件无显著相关,但与隐源性卒中患者的复发性卒中相关。
BACKGROUND: Left atrial appendage (LAA) slow-flow may increase the risk of ischemic stroke. We studied LAA attenuation on cardiac computed tomography in patients with acute ischemic stroke.
RESULTS: We used data from a prospective cohort of patients with acute ischemic stroke undergoing cardiac computed tomography during the acute stroke imaging protocol. We compared characteristics, functional outcome (modified Rankin scale: higher scores indicating worse outcome), stroke recurrence and major adverse cardiovascular events after 2-year follow-up between patients with LAA thrombus (filling defect<100 Hounsfield Unit (HU)), slow-flow (filling defect ≥100 HU) and normal filling. Of 421 patients, 31 (7%) had LAA thrombus, 69 (16%) slow-flow, and 321 (76%) normal filling. Patients with thrombus or slow-flow more often had known atrial fibrillation compared with normal filling (45%, 39%, and 9%, P<0.001). Patients with thrombus had higher National Institutes of Health Stroke Scale-scores compared with slow-flow and normal filling (18 [interquartile range, 9-22], 6 [interquartile range, 3-17], and 5 [interquartile range, 2-11], P<0.001). Compared with normal filling, there was no difference with slow-flow in functional outcome (median modified Rankin scale, 3 versus 2; acOR 0.8 [95% CI, 0.5-1.4]), stroke recurrence (adjusted hazard ratio, 0.8 [95% CI, 0.3-1.9]) or major adverse cardiovascular events (adjusted hazard ratio, 1.2 [95% CI, 0.7-2.1]), while patients with thrombus had worse functional outcome (median modified Rankin scale, 6, acOR, 3.3 [95% CI, 1.5-7.4]). In cryptogenic stroke patients (n=156) slow-flow was associated with stroke recurrence (27% versus 6%, aHR, 4.1 [95% CI, 1.1-15.7]).
CONCLUSIONS: Patients with slow-flow had similar characteristics to patients with thrombus, but had less severe strokes. Slow-flow was not significantly associated with functional outcome or major adverse cardiovascular events, but was associated with recurrent stroke in patients with cryptogenic stroke.