精准医学杂志 (Aug 2023)
ASSOCIATION OF LEFT ATRIAL ENLARGEMENT WITH THE ONSET OF STROKE IN CRYPTOGENIC STROKE PATIENTS WITH RIGHT-TO-LEFT SHUNT
Abstract
Objective To investigate the association between right-to-left shunt (RLS) and left atrial enlargement (LAE) and in cryptogenic stroke (CS) patients with RLS, as well as the association between LAE and the onset of stroke in CS patients with RLS. Methods General information and cardiac parameters on transthoracic echocardiography were collected from 211 CS patients (CS group) and 211 non-stroke patients (control group) who were admitted to department of neurology of our hospital, from May 2016 to December 2022, and transcranial Doppler was used to determine the presence or absence of RLS and the degree of RLS. According to the presence or absence of RLS, the patients in the CS group were further divided into CSRLS-positive group and CSRLS-negative group, and the patients in the control group were further divided into RLS-positive control group and RLS-negative control group; according to the degree of RLS, the CSRLS-positive group was further divided into severe RLS group and mild RLS group. Related indicators were compared between the CS group and the control group, between the CSRLS-positive group and the CSRLS-negative group, between the severe RLS group and the mild RLS group, and between the CSRLS-positive group and the RLS-positive control group, and a multivariate logistic regression analysis was used to identify the influence factors for the onset of stroke in CS patients with RLS. Results There were significant differences in cardiac parameters between the CS group and the control group (t=-10.65--2.45,P<0.05). Compared with the CSRLS-negative group, the CSRLS-positive group had significantly greater left atrial diameter (LAD), left atrial short diameter, left atrial long diameter, and pulmonary artery systolic pressure (PASP) (t=-7.82--2.30,P<0.05), and the severe RLS group had a significantly larger LAD than the mild RLS group (t=-2.39,P<0.05). There were significant differences between the CSRLS-positive group and the RLS-positive control group in the proportions of patients with male sex, smoking history, drinking history, hypertension, and diabetes, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, interventricular septum, left ventricular posterior wall, LAD, left atrial long diameter, and PASP (t=-9.80-11.42,P<0.05). The multivariate logistic regression analysis showed that the increase in LAD was independently associated risk factor of onset of stroke in CS patients with RLS (P<0.05). Conclusion LAE might be associated with the presence and degree of RLS in CS patients, and the increase in LAD might be associated with the onset of stroke in CS patients with RLS.
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