【摘要】 目的 应用超声二维斑点追踪技术评估左房应变功能，探讨其在非瓣膜性房颤(NVAF)患者发生缺血性脑卒中风险评估中的应用价值。方法 选取2020年10月至2021年7月因非瓣膜性房颤在大连市中心医院住院患者181例，按是否合并缺血性脑卒中分为脑卒中组(40例)和非脑卒中组(141例);比较两组临床、左房应变功能等参数，应用单、多因素Logistic回归分析影响非瓣膜性房颤患者发生缺血性脑卒中的因素。采用受试者工作特征曲线(ROC)评价左房整体纵向应变(LA GLS)联合CHA2DS2-VASC评分对非瓣膜性房颤患者发生缺血性脑卒中风险的预测价值。结果 脑卒中组患者年龄、心率、CHA2DS2-VASC评分、国际标准化比值(INR)、左房内径(LAD)、左房容积(LAV)及左房容积指数(LAVI)均高于非脑卒中组(P<0.05),其左房射血分数(LAEF)、LA GLS均低于非脑卒中组(P<0.05)。单、多因素Logistic回归分析显示，LAD、LAEF、LA GLS与非瓣膜性房颤患者发生缺血性脑卒中相关(P<0.05),LAD、LA GLS是其独立影响因素(P<0.05)。CHA2DS2-VASC评分、LAD联合CHA2DS2-VASC评分、LA GLS联合CHA2DS2-VASC评分预测非瓣膜性房颤患者发生缺血性脑卒中风险ROC曲线下面积(AUC)依次为0.833、0.862、0.902,差异均具有统计学意义(P<0.05)。结论 左房应变功能指标LA GLS联合CHA2DS2-VASC评分在非瓣膜性房颤患者发生缺血性脑卒中风险评估中具有一定的应用价值。更多还原

【Abstract】 Objective To evaluate the value of left atrial strain in the risk assessment of ischemic stroke in patients with non-valvular atrial fibrillation(NVAF) by two-dimensional speckle tracking ultrasound technique.Methods 181 patients with NVAF were enrolled in our study from October 2020 to July 2021.All patients were divided into stroke group(n=40) and non-stroke group(n=141) according to whether they were complicated with ischemic stroke or not.The clinical and left atrial structure and function parameters of the two groups were compared, and univariate and multivariate Logistic regression analysis was used to analyze the factors affecting stroke in patients with NVAF.The AUC of different risk assessment models is compared by ROC.Results The age, heart rate, CHA2DS2-VASC score, INR,left atrial diameter(LAD),left atrial volume(LAV) and left atrial volume index(LAVI) in the stroke group were higher than those in the non-stroke group, while the left atrial ejection fraction(LAEF) and left atrial longitudinal strain(LA GLS) in the stroke group were lower than those in the non-stroke group.Univariate and multivariate Logistic regression analysis showed that LAD,LAEF and LA GLS were associated with stroke in patients with NVAF,while LAD and LA GLS were independent influencing factors.ROC showed that the AUC of CHA2DS2-VASC score, model 1(LAD combined with CHA2DS2-VASCscore) and model 2(LA GLS combined with CHA2DS2-VASC score) to evaluate the risk of stroke in patients with NVAF were 0.833,0.862 and 0.902 respectively(P<0.001).Conclusion The left atrial strain function LA GLS combined with CHA2DS2-VASC score has certain application value in the risk assessment of ischemic stroke in patients with NVAF patients.更多还原