BACKGROUND The current risk stratification schemes for stroke in patients with atrial fibrillation (AF) are insufficient for an accurate assessment of stroke risk. AIMS This study evaluates the association between the mechanical function of the left atrial appendage (LAA), as assessed by angiography, and the risk of stroke. METHODS We conducted a cross-sectional study to assess the mechanical function of the LAA by measuring the left atrial appendage ejection fraction (LAAEF) and grading the contrast retention (CR) using angiography. RESULTS A total of 746 patients referred for a left atrial appendage occlusion (LAAO) procedure with (n=151; stroke group) or without (n=595; control group) a history of stroke were included in the analysis. LAAEF was significantly lower (14% [9-19] vs 20% [12-33]; p<0.001) and grade 3 CR was more common (66.9% vs 33.9%; p<0.001) in patients with a history of stroke. Multivariable analysis showed that CR was independently associated with stroke in patients with AF (grade 2 vs grade 1=7.29; 95% confidence interval [CI]: 2.84-21.65; p<0.001; grade 3 vs grade 1=16.45; 95% CI: 6.16-51.02; p<0.001). The receiver operating characteristics curve demonstrated that CR identified patients with stroke more accurately than the CHA2D-VASc score (C-statistic 0.712 vs 0.512; p<0.001), and the combination of CR and the CHA2DS2-VASc score provided the best performance (C-statistic 0.871 vs 0.829 [CHA2DS2-VASc score alone]; p=0.048) Conclusions: Impaired mechanical function of the LAA, indicated by a low LAAEF and CR, is associated with a history of stroke in patients with AF. Assessment of CR using LAA angiography helps improve the stratification scheme for stroke risk prediction.

中文翻译：

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左心耳血管造影用于房颤患者中风风险预测。

背景目前房颤（AF）患者中风的风险分层方案不足以准确评估中风风险。目的 本研究评估通过血管造影评估的左心耳 (LAA) 机械功能与中风风险之间的关联。方法 我们进行了一项横断面研究，通过测量左心耳射血分数 (LAAEF) 并使用血管造影对造影剂保留 (CR) 进行分级来评估左心耳的机械功能。结果 共有 746 名转诊接受左心耳封堵 (LAAO) 手术的患者（n=151；中风组）或无中风病史（n=595；对照组）纳入分析。有卒中病史的患者中，LAAEF 显着较低（14% [9-19] vs 20% [12-33]；p<0.001），3 级 CR 更常见（66.9% vs 33.9%；p<0.001） 。多变量分析显示，CR 与 AF 患者卒中独立相关（2 级与 1 级=7.29；95% 置信区间 [CI]：2.84-21.65；p<0.001；3 级与 1 级=16.45；95% CI ：6.16-51.02；p<0.001）。受试者工作特征曲线表明，CR 比 CHA2D-VASc 评分更准确地识别中风患者（C 统计量 0.712 vs 0.512；p<0.001），并且 CR 和 CHA2DS2-VASc 评分的组合提供了最佳性能（C 统计量 0.712 vs 0.512；p<0.001）。 - 统计数据 0.871 vs 0.829 [仅 CHA2DS2-VASc 评分]；p=0.048) 结论：LAAEF 和 CR 较低表明的 LAA 机械功能受损与 AF 患者的中风病史相关。使用左心耳血管造影评估 CR 有助于改进中风风险预测的分层方案。