综合超声技术检测非瓣膜性房颤缺血性脑卒中栓子来源的研究

目的研究非瓣膜性心房颤动(房颤)患者缺血性脑卒中可能的栓子来源。方法非瓣膜性房颤患者140例,应用经食管超声心动图(TEE)和外周血管超声技术检测缺血性脑卒中的左房危险因素(左房和/或左心耳内有重度自发声学显影和血栓)、主动脉危险因素(升主动脉和主动脉弓粥样斑块)、颈动脉危险因素(颈动脉复合型粥样斑块)和卵圆孔未闭。结果140例患者中21例(15%)发生缺血性脑卒中。具有左房、主动脉和颈动脉危险因素者分别为61.4%(86/140)、8.6%(12/140)和20.0%(28/140),脑卒中发生率分别为20.9%(18/86)、16.7%(2/12)和39.3%(11/28),同时存在左房和颈动脉危险因素者占14.3%(20/140),脑卒中发生率为50.0%(10/20);无危险因素者占28.6(40/140),脑卒中发生率为2.5%(1/40)。存在危险因素患者脑卒中的发生率明显高于无危险因素者(P<0.05～0.001)。结论左房、主动脉、颈动脉危险因素是房颤患者缺血性脑卒中的主要栓子来源,同时存在多种危险因素,特别是同时存在左房和颈动脉危险因素的房颤患者为脑卒中的高危人群;TEE和外周血管超声为房颤患者栓塞的进一步危险分层提供了精确方法。

The Echocardiography for the Evaluation of Potential Sources for Ischemic Cerebral Stroke Embolism in Patients with Nonvalvular Atrial Fibrillation

Objective To define potential sources of ischemic cerebral stroke embolism in patients with nonvalvular atrial fibrillation by ehocardiography.Methods Transesophageal echocardiogram(TEE)and carotid artery ultrasonogram were performed in 140 patients with nonvalvular atrial fibrillation.Spontaneous echocardi-ographic contrast(SEC)and thrombus in left atrium and left atrial appendage,atherosclerotic plaque on the aortic arch and carotid artery and patent foramen ovale were detected.Results 21/140(15%)ischemic cerebral strokes occurred.Dense SEC and thrombus in left atrium and left atrial appendage,atherosclerotic lesions in the aortic arch and the complex plaque in the carotid artery were detected in 61%(86/140),8.6%(12/140) and 20.0%(28/140)of patients respectively.The rate of cerebral ischemic events were 21%(18/86),17%(2/12) and 39%(11/28)respectively.14%(20/140)of patients had both left atrial abnormality and complex carotid plaque and the rate of cerebral ischemic events was 50%(10/20).29%(40/140)of patients without any risk factors had lower event rate(2.5%)compared with the patients with risk factors(P<0.05~0.001).Conclusions The left atrial abnormality,arotic arch atherosclerotic lesions and complex corotid plaque are the important source of cerebral embolism in patients with nonvalvular atrial fibrillation.TEE and carotid artery ultrasonography provide a unique tool for stratification high risk patients.