Two-dimensional speckle tracking imaging analyses of the correlations between left atrial appendage function and stroke risk in nonvalvular atrial fibrillation patients

作者全名："Zheng, Xiwangmin; Ran, Haitao; Ren, Jianli; Ling, Zhiyu; Hou, Lingli; Ao, Meng; Zhu, Yefeng; Zhang, Maohui; Han, Ying; Li, Shiyu; Zhou, Xia; Yu, Qiujin; Luo, Peng; Su, Lei"

作者地址："[Zheng, Xiwangmin; Ran, Haitao; Ren, Jianli; Ao, Meng; Zhu, Yefeng; Zhang, Maohui; Han, Ying; Li, Shiyu; Zhou, Xia; Yu, Qiujin; Luo, Peng; Su, Lei] Chongqing Med Univ, Dept Ultrasound, Affiliated Hosp 2, 74 Linjiang Rd, Chongqing 40010, Peoples R China; [Ling, Zhiyu] Chongqing Med Univ, Dept Cardiol, Affiliated Hosp 2, Chongqing, Peoples R China; [Hou, Lingli] Kunming Med Univ, Dept Ultrasound, Affiliated Qujing Hosp, Yunnan, Peoples R China"

通信作者："Su, L (通讯作者)，Chongqing Med Univ, Dept Ultrasound, Affiliated Hosp 2, 74 Linjiang Rd, Chongqing 40010, Peoples R China."

来源：INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001126335000001

JCR分区：Q3

影响因子：1.5

年份：2023

卷号：　

期号：　

开始页：　

结束页：　

文献类型：Article; Early Access

关键词：Atrial fibrillation; Stroke; Left atrial appendage; Speckle tracking imaging

摘要："Stroke incidence is the most severe complication associated with atrial fibrillation (AF), and the most common site of thrombus formation in AF patients is the left atrial appendage (LAA). This study was developed to use two-dimensional speckle tracking imaging (2D-STI) to explore associations between LAA strain/strain rate and stroke incidence and to evaluate the value of utilizing LAA strain and strain rate values to support the stratification of nonvalvular AF (NVAF) patients based on stroke risk. A total of 486 AF patients who had undergone transesophageal echocardiography to exclude potential intracardiac thrombosis between March 2021 and November 2022 were consecutively enrolled. Patients meeting the inclusion criteria were separated into two groups according to their history of stroke/transient ischemic attack (TIA). LAA strain and strain rate values in these patients were measured via 2D-STI. Multivariable logistic regression analysis was employed to determine independent risk factors for the construction of a combined predictive model. Of the 333 analyzed patients (134 females, aged 65 (56,72) years), 39 (11.71%, 39/333) had a history of stroke at the time of evaluation. Multivariate logistic regression analysis demonstrated that nonparoxysmal AF, CHA2DS2VASc score, LAA thrombus/spontaneous echo contrast (SEC), LAA strain, and strain rate were all predictors of stroke incidence among NVAF patients. The combined predictive model demonstrated excellent discriminative ability, with an AUC of 0.91 (95%CI 0.87-0.95, P < 0.001), and a sensitivity and specificity of 79.49% and 89.46%, respectively. The Hosmer-Lemeshow test confirmed good calibration, yielding a value of 0.98. Comparative decision curve analysis showed that the model provided superior net benefits compared to the CHA2DS2VASc score. Furthermore, the model exhibited improved predictive performance and reclassification for stroke when compared to the CHA2DS2VASc score (AUC 0.91 vs. 0.88, Z = 2.32, P = 0.02), accompanied by a significant increase in the net reclassification index (+ 5.44%, P < 0.001) and integrated discrimination improvement (8.21%, P < 0.001). These data demonstrate that LAA strain and strain rate, as measured via 2D-STI, can offer value when assessing LAA function in AF patients, potentially providing further predictive value to extant clinical risk scoring strategies."

基金机构：Chongqing medical scientific research project(Joint project of Chongqing Health Commission and Science and Technology Bureau)

基金资助正文：None.