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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Association between electrocardiographic and echocardiographic atrial abnormalities and prognosis in cryptogenic stroke
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Association between electrocardiographic and echocardiographic atrial abnormalities and prognosis in cryptogenic stroke

机译：心电图与超声心动图性心房异常和隐性中风预后的关系

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Background and Purpose: The role of atrial fibrillation in cryptogenic stroke (CS) is well known. However, the usefulness of left atrial (LA) electrical and morphological abnormalities to identify more disabling strokes in sinus rhythm patients is less studied. We evaluated the association between electrocardiographic P-wave abnormalities and echocardiographic LA measures with neurological disability in patients with cryptogenic stroke. Methods: In a retrospective cohort, we included all consecutive hospitalized patients with cryptogenic stroke. Patients were classified according to modified Rankin scale at hospital discharge and at 3 months. LA abnormalities were identified by electrocardiographic (ECG) P-wave, axis and LA enlargement criteria, and by bidimensional echocardiograph through left atrial diameter and volume index. Results: Among the 143 patients with CS (63.4 +/- 14.2 years, 53% women), 70 patients were classified as non-disabling stroke (Rankin score = 2) at hospital discharge. On echocardiogram, more patients with disabling stroke presented with enlarged LA volume index (48% vs. 25%; p = 0.01). This difference remained significant after adjustment for age, gender, CHA(2)DS(2)-VASc and NIHSS scores (p = 0.02) and even when the LA volume index was analyzed as a continuous variable (p = 0.055). Also, enlarged LA volume index was more prevalent (52% vs. 25%; p = 0.03) among those with disabling stroke at 3 months after hospital discharge. Among ECG criteria, only the LA enlargement assessed by downward deflection was more prevalent in disabling stroke. Conclusion: Our study demonstrated an association between left atrial enlargement, assessed by downward deflection from ECG and volume index from echocardiogram, and more disabling cryptogenic strokes. This information could help to identify patients with poorer prognosis, or a subgroup where atrial cardiopathy may play a role in cardioembolic pathway. (c) 2020 Elsevier Inc. All rights reserved.
机译：背景和目的：心房颤动在隐源性卒中（CS）中的作用是众所周知的。然而，左心房（LA）电和形态学异常在窦性心律患者中识别更多致残性卒中的有用性研究较少。我们评估了隐源性卒中患者心电图P波异常和超声心动图LA测量与神经功能障碍之间的关联。方法：在回顾性队列研究中，我们纳入了所有连续住院的隐源性卒中患者。患者在出院时和3个月时根据改良的Rankin量表进行分类。通过心电图（ECG）P波、轴和LA增大标准，以及通过左心房直径和容积指数的二维超声心动图，确定LA异常。结果：在143例CS患者中（63.4+/-14.2岁，53%为女性），70例患者在出院时被归类为非致残性卒中（Rankin评分=2）。在超声心动图上，更多的致残性卒中患者表现为LA容积指数增大（48%对25%；p=0.01）。调整年龄、性别、CHA（2）DS（2）-VASc和NIHSS评分（p=0.02）后，即使将LA容积指数作为连续变量进行分析（p=0.055），这种差异仍然显著。此外，在出院后3个月患有致残性卒中的患者中，LA容积指数增大更为普遍（52%对25%；p=0.03）。在ECG标准中，只有通过向下偏转评估的LA增大在致残性卒中中更为普遍。结论：我们的研究证实了左心房扩大与更多致残性隐源性卒中之间的关联，前者通过心电图向下偏移和超声心动图容积指数进行评估。这些信息有助于确定预后较差的患者，或心房性心脏病可能在心肌栓塞途径中发挥作用的亚组。（c） 2020爱思唯尔公司版权所有。

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