Coronary CTA to Investigate Predictive Value of Left Atrial Appendage for Cardiogenic Stroke in Patients with Nonvalvular Atrial Fibrillation

Abstract

Purpose. To investigate the predictive value of changes in LAA size and function for cardiogenic stroke (CS) in patients with NVAF by coronary CTA examination. Materials and Method. 179 patients with NVAF were selected and grouped according to the outbreak of acute ischemic stroke and TIA within 2 years after coronary CTA examination. Those who met the criteria for CS were selected as cases (87 patients), and those neither stroke nor TIA as controls (92 patients). LAA size of selected patients was measured and data postprocessing was performed. The differences of baseline data and LAA parameters between groups were analyzed. The impacts of BMI, hyperlipidemia, the duration of AF, the LAAOA Index, and the LAAEF on CS were assessed by binary logistic regression. The predictive abilities of LAAOA Index, LAAEF, and the combined predictor were assessed by ROC curves. Results. Proportions of BMI ≥ 25 , prevalence of hyperlipidemia, duration of AF, and LAAODmax, LAAODmin, LAAOA, LAAVmax, and LAAVmin with their correction index were greater in cases than controls. The LAAEF was lower in cases than that in controls. The binary logistic regression model showed an increase in LAAOA Index ( P = 0.005 ) and a decrease in LAAEF ( P < 0.001 ) were independent risk factors for CS. ROC curve analysis showed that the optimal cutoff values of LAAOA Index and LAAEF to predict CS were 3.16 cm2/m2 and 38.71%, with AUC value of 0.712 and 0.734, respectively. The LAAOA Index-LAAEF combined predictor (AUC value = 0.786 ) was likely superior to either LAAOA Index or LAAEF. Conclusions. Coronary CTA can provide additional valuable parameters, as a by-product of coronary artery assessment without additional radiation dose, for the risk assessment of CS in patients with NVAF. Coronary CTA may make up for the limitation of single indicator of CHA2DS2-VASc in guiding anticoagulation program, to reduce the incidence of embolism and bleeding events.

Correlation of Computed Tomographic Angiography in Patients Undergoing Coronary Artery Bypass Grafting and Effect of Standardized Rehabilitation Nursing

“…CHD is a chronic disease, and in addition to the need for good treatment and diagnosis methods, postoperative care also plays an important role in the prognosis of patients to improve the survival rate and quality of life of patients. Standardized rehabilitation nursing is one of the nursing methods that are used more and more concerned in clinical practice [ 12 ]. Some foreign scholars use standardized rehabilitation care to reduce the incidence of CHD by 50%.…”