超声心电图参数对非瓣膜性房颤相关脑栓塞的预测价值

The Value of Electrocardiographic Parameters in Predicting Non-Valvular Atrial Fibrillation-Related Stroke

摘要: 目的：探究超声心电图参数对非瓣膜性房颤相关脑栓塞的预测价值。方法：我们选取脑梗死患者210例，包括非瓣膜性房颤(NVAF)相关脑栓塞患者98例及非心源性栓塞患者112例，比较两组间差异，应用二元Logsitic回归分析筛选出NVAF相关脑栓塞的独立危险因素，绘制受试者工作特征曲线(ROC)判断各危险因素对NVAF相关脑栓塞的预测价值。结果：NVAF相关脑栓塞患者较非心源性栓塞患者左房内径水平高，左室射血分数水平低。二元Logistic分析显示左房内径(OR = 17.159, 95%CI: 4.429~66.471, P < 0.001)及左室射血分数(OR = 0.899, 95%CI: 0.824~0.98, P = 0.016)是NVAF相关脑栓塞的独立危险因素。左房内径、左室射血分数及两种指标联合模型预测NVAF相关脑栓塞患者的受试者工作特征(ROC)曲线下面积分别为0.826、0.658、0.846 (P < 0.001)。结论：超声心动图参数对预测NVAF相关脑栓塞有显著价值，尤其是左房内径。左房内径及左室射血分数可作为早期发现NVAF相关卒中患者的筛查工具。

Abstract: Objective: To investigate the value of electrocardiographic parameters in predicting non-valvular atrial fibrillation-related stroke. Materials and Methods: A total of 210 patients with acute ischemic stroke, including 98 patients with non-valvular atrial fibrillation (NVAF)-related stroke and 112 pa-tients with non-cardiogenic embolism were selected. The differences between the two groups were compared, and independent risk factors of NVAF-related stroke were screened using binary logistic regression analysis. The diagnostic value of risk factors for NVAF-related stroke was determined by plotting the receiver operating characteristic (ROC) curves. Results: Patients with NVAF-related stroke had higher levels of left atrial diameter and lower levels of left ventricular ejection fraction than those with non-cardiogenic embolism. Binary logistic regression analysis indicated that left atrial diameter (LAD) (OR = 17.159, 95%CI: 4.429~66.471, P < 0.001) and left ventricular ejection fraction (LVEF) (OR = 0.899, 95%CI: 0.824~0.98, P = 0.016) were independent risk factors for NVAF-related stroke. The areas under the ROC curve for LAD, LVEF, and the combined model of two indicators were 0.826, 0.658, and 0.846, respectively, that predicted the incidence of NVAF-related stroke (P < 0.001). Conclusions: Echocardiographic parameters have significant value in predicting NVAF-related cerebral embolism, especially LAD. LAD and LVEF could be used as screening tools to identify NVAF-related stroke patients early.