The clinical association of left atrial appendage thrombus on CTA with functional outcome.

IF 4.5 3区 医学 Q1 CLINICAL NEUROLOGY
Joel Winders, Angelo Di Bartolo, Jamin Kim, Duncan Wilson, Sajith Senadeera, Yassar Alamri, John Fink, James Beharry, Mark W Parsons, Christopher Levi, Neil Spratt, Beng Lim Alvin Chew, Md Golam Hasnain, Ferdinand Miteff, Leon Rinkel, Shan Sui Nio, Sinan Al-Hadethi, Anthony Lim, Jonathan Coutinho, Carlos Garcia-Esperon, Teddy Y Wu, Alexander Berry-Noronha
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Abstract

Background: Left atrial appendage (LAA) thrombus is associated with atrial fibrillation (AF) and can be a marker of atrial cardiomyopathy. We determined the association between computed tomography angiography (CTA) identified LAA thrombus in patients presenting with acute ischaemic stroke or transient ischaemic attack (TIA), and 3-month outcome.

Methods: We undertook a dual-centre, retrospective cohort study from New Zealand and Australia. All consecutive patients presenting with acute ischaemic stroke or TIA during the inclusion period who underwent acute stroke imaging were included. We analysed the association with CTA-LAA thrombus and 3-month outcome on modified Rankin Scale using multivariable logistic regression models adjusted for known predictors of outcome.

Results: Of the 1435 patients included, 1304 (90.9%) had acute ischaemic stroke and 131 (9.1%) had TIA. 582 (41%) had confirmed intracranial medium or large vessel occlusion (MLVO), and 565 (40%) received reperfusion therapies. CTA-LAA thrombus was identified in 58 (4.0%) patients, and these patients were older (median age 85 (IQR 75-88) vs 73 (63-81), p < 0.01), more likely to be female (62% vs 40%, p < 0.01), had higher rates of AF (79% vs 29%, p < 0.01), heart failure (29% vs 9%, p < 0.01), MLVO (53% vs 40%, p = 0.05), and mortality at 3-months (28% vs 11%, p < 0.01). Adjusting for known predictors of poor outcome, LAA thrombus was independently associated with increased 3-month mRS score (OR: 2.02, 95% CI: 1.20-3.40, p < 0.01).

Conclusions: CTA-LAA thrombus detected during the acute stroke imaging protocol in patients with ischemic stroke or TIA is a predictor of worse outcome.

CTA显示左心耳血栓与功能预后的临床关系。
背景:左心耳(LAA)血栓与心房颤动(AF)相关,可作为心房心肌病的标志。我们确定了计算机断层血管造影(CTA)在急性缺血性卒中或短暂性缺血性发作(TIA)患者中发现的LAA血栓与3个月预后之间的关系。方法:我们在新西兰和澳大利亚进行了一项双中心、回顾性队列研究。所有在纳入期间连续出现急性缺血性卒中或TIA的患者均接受了急性卒中影像学检查。我们分析了CTA-LAA血栓与改良Rankin量表3个月预后的关系,使用多变量logistic回归模型调整已知预后预测因子。结果:1435例患者中,1304例(90.9%)发生急性缺血性脑卒中,131例(9.1%)发生TIA。582例(41%)确诊颅内中大血管闭塞(MLVO), 565例(40%)接受再灌注治疗。在58例(4.0%)患者中发现了CTA-LAA血栓,这些患者年龄较大(中位年龄85 (IQR 75-88) vs 73 (63-81), p p p p = 0.05), 3个月死亡率(28% vs 11%, p p结论:缺血性卒中或TIA患者在急性卒中成像方案中检测到CTA-LAA血栓是预后较差的预测因子。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.50
自引率
6.60%
发文量
102
期刊介绍: Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
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