Atriyal fibrilasyon ve asemptomatik serebral infarkt ilişkisi

Abstract

ÖZET ATRİYAL FİBRİLASYON VE ASEMPTOMATİK SEREBRAL İNFARKT İLİŞKİSİ Atriyal fibrilasyonlu (AF) vakalarda asemptomatik serebral infarkt sıklığını saptamak amacıyla ortalama yaşları 57.6+14.7 (25-86) arasında olan 30(%44.8) erkek, 37(%55.7) kadın toplam 67 atriyal fibrilasyonlu vaka çalışmaya alındı. Tüm hastaların kardiyovasküler ve nörolojik muayeneleri ile birlikte, transtorasik ve transözofageal ekokardiyografileri, bilateral karotis Doppler ultrasonografisi ile bilgisayarlı beyin tomografileri çekildi. Vakaların %50.7 non-valvüler AF, %49.3 valvüler AF, %85.1 kronik AF, %14.9 paroksismal AF'luydu. Vakaların % 37. 3 'ünde sol atriyal ekokontrastı (SAK) tespit edildi. Sol atriyal ekokontrastı yaş ve sağ atriyal ekokontrastı dışında diğer parametrelerle anlamlı ilişki göstermiyordu. Sol atriyal trombus (SAT) %26.5 vakada mevcuttu. Sol atriyal trombüs diğer parametrelerle anlamlı ilişki göstermiyordu (p>0.05). Vakaların %44.8'inde karotis arter plağı %31.3'inde ise aortik aterom plağı tespit edildi. Bilgisayarlı beyin tomografisinde AF'lu vakaların %56.8'inde serebral infarkt tespit edildi. Serebral infarktlarm çoğunluğu laküner tipte, derin yerleşimli ve tek lezyon şeklindeydi. Lokalizasyon açısından dağılım istatistiksel anlam taşımıyordu (p>0.05). Serebral infarkt tespit edilen vakaların yaş, AF süresi, AF etiyolojisi, AF tipi, hipertansiyon, karotis arterde ve aorta da plak varlığı, sigara, aspirin ve kumadin kullanımı ve ekokardiyografik parametrelerle ilişkisi anlamlı değildi (p>0.05). Asemptomatik serebral infarktı olan vakaların %44.7'sinde SAK, %34.2'sinde SAT, % 5. 2' sinde ise SAK ve SAT birlikte bulunmaktaydı. Asemptomatik serebral infarkt SAK (p= 0.006), SAT (p = 0.03) ile pozitif yönde anlamlı ilişki gösteriyordu. Sonuç olarak AF'lu vakaların yarısında asemptomatik serebral infarkt tespit edildi ve sol atriyal ekokontrastı ve sol atriyal trombüs asemptomatik serebral infarkt için en önemli risk faktörü olarak bulundu. Anahtar Kelimeler: Atriyal fıbrilasyon, asemptomatik serebral infarkt, sol atriyal ekokontrastı, sol atriyal trombüs, aortik aterom plakları. VISUMMARY ASYMPTOMATIC CEREBRAL INFARCTION IN PATIENTS WITH ATRIAL FIBRILLATION This study was performed to investigate of the frequency of asymptomatic cerebral infarct in patients with atrial fibrillation whose mean ages were 57.6+14.7 (between 25- 86) and 30(44.8%) were men and 37(55.7%) were women. Cardiovascular and neurologic examinations, transthoracic and transeosophageal echocardiographic investigation, bilateral carotis Doppler ultrasonography and computerized brain tomography were performed for all patients. Thirty-seven patients (55.7%) of all cases had non-valvular atrial fibrillation (AF), 49.3% had valvular AF, 85.1% had chronic AF, and 14.9% had paroxysmal AF. Left atrial spontaneous echocontrast was found in patients of all cases 37.3%. Left atrial spontaneous echocontrast didn't show any significance when it was compared other parameters except age and right atrial spontaneous echocontrast. Left atrial thrombus was found in patients 26.5%. Left atrial didn't show any significance other parameter, either (p > 0.05). Carotid artery plaque and aortic atheroma plaque were found in patients 44.8% and patients 31.3% respectively. Cerebral infarct was found in patients 56.8% of patients with atrial fibrillation via computerized brain tomography. The most of the cerebral infarcts were lacunar type, single, and localizations of them were deep. Localizations of these infarcts were not statistically significant. There was no correlation between the cerebral infarct and age, duration of AF, etiology of AF, type of AF, hypertension, carotid artery and aortic plaque, cigarettes, aspirin and coumadine usage, and echocardiographic parameters (p>0.05). Seventeen patients (44.7%) of asymptomatic cerebral infarct had left atrial spontaneous echocontrast, in patients 34.2% had left atrial thrombus, and patients 5.2% had left atrial spontaneous echocontrast and left atrial thrombus together. It was found that positive correlation between asymptomatic cerebral infarct and left atrial spontaneous echocontrast (p = 0.006) and left atrial thrombus (p=0.03). In conclusion; the half of the patients with atrial fibrillation were found cerebral infarct and left atrial spontaneous echocontrast and left atrial thrombus were found the most important risk factor for asymptomatic cerebral infarct in patients with atrial fibrillation. Key Words: Atrial fibrillation, asymptomatic cerebral infarct, left atrial spontaneous echocontrast, left atrial thrombus, aortic atheroma plaques. VII

SUMMARY ASYMPTOMATIC CEREBRAL INFARCTION IN PATIENTS WITH ATRIAL FIBRILLATION This study was performed to investigate of the frequency of asymptomatic cerebral infarct in patients with atrial fibrillation whose mean ages were 57.6+14.7 (between 25- 86) and 30(44.8%) were men and 37(55.7%) were women. Cardiovascular and neurologic examinations, transthoracic and transeosophageal echocardiographic investigation, bilateral carotis Doppler ultrasonography and computerized brain tomography were performed for all patients. Thirty-seven patients (55.7%) of all cases had non-valvular atrial fibrillation (AF), 49.3% had valvular AF, 85.1% had chronic AF, and 14.9% had paroxysmal AF. Left atrial spontaneous echocontrast was found in patients of all cases 37.3%. Left atrial spontaneous echocontrast didn't show any significance when it was compared other parameters except age and right atrial spontaneous echocontrast. Left atrial thrombus was found in patients 26.5%. Left atrial didn't show any significance other parameter, either (p > 0.05). Carotid artery plaque and aortic atheroma plaque were found in patients 44.8% and patients 31.3% respectively. Cerebral infarct was found in patients 56.8% of patients with atrial fibrillation via computerized brain tomography. The most of the cerebral infarcts were lacunar type, single, and localizations of them were deep. Localizations of these infarcts were not statistically significant. There was no correlation between the cerebral infarct and age, duration of AF, etiology of AF, type of AF, hypertension, carotid artery and aortic plaque, cigarettes, aspirin and coumadine usage, and echocardiographic parameters (p>0.05). Seventeen patients (44.7%) of asymptomatic cerebral infarct had left atrial spontaneous echocontrast, in patients 34.2% had left atrial thrombus, and patients 5.2% had left atrial spontaneous echocontrast and left atrial thrombus together. It was found that positive correlation between asymptomatic cerebral infarct and left atrial spontaneous echocontrast (p = 0.006) and left atrial thrombus (p=0.03). In conclusion; the half of the patients with atrial fibrillation were found cerebral infarct and left atrial spontaneous echocontrast and left atrial thrombus were found the most important risk factor for asymptomatic cerebral infarct in patients with atrial fibrillation. Key Words: Atrial fibrillation, asymptomatic cerebral infarct, left atrial spontaneous echocontrast, left atrial thrombus, aortic atheroma plaques. VII