陈炳霖,杨桂平,潘兴寿

过去30年中，我国脑梗死患病率明显上升，目前我国脑梗死现患人数高居世界首位；我国脑梗死发病率呈显著上升趋势，与发达国家降低趋势相反。随着人口老龄化程度的持续加深，脑梗死相关危险因素控制欠佳等问题持续存在，脑梗死导致的疾病负担在我国呈现日益加重的趋势。研究显示绝大部分脑梗死患者都合并着心血管疾病（Cardiovascular disease，CVD），高血压、冠心病、房颤占比分别为66.5%、30.3%和21.4%。目前发现脑梗死的主要影像学方法为电子计算机断层扫描（Computed tomography，CT）和磁共振成像（Magnetic Resonance Imaging，MRI），近年来，随着超声技术的不断发展，借助心脏彩超，能够对CVD患者的心腔大小、心肌厚度、心脏收缩和舒张功能以及瓣膜状态等关键指标进行评估，从而为早期识别CVD患者并发脑梗死提供重要的参考依据。

心脏彩超；脑梗死；心血管疾病

[1] DISEASES NATIONAL CENTER FOR CARDIOVASCULAR,CHINA THE WRITING COMMITTEE OF.中国心血管健康与疾病报告2024概要[J].中国循环杂志,2025,40(06):521-559. [2] 武龙君,李勤英,杨利平.心脏彩超在高血压性心脏病患者病情评估中的临床价值[J].黑龙江医药科学,2024,47(5):81-82,85. [3] WANG Y,LI Z,GU H,et al.China Stroke Statistics 2019:A Report From the National Center for Healthcare Quality Management in Neurological Diseases,China National Clinical Research Center for Neurological Diseases,the Chinese Stroke Association,National Center for Chronic and Non-communicable Disease Control and Prevention,Chinese Center for Disease Control and Prevention and Institute for Global Neuroscience and Stroke Collaborations[J].Stroke and Vascular Neurology,2020,5(3):211-239. [4] VIRANI S S,ALONSO A,BENJAMIN E J,et al.Heart Disease and Stroke Statistics-2020 Update:A Report From the American Heart Association[J].Circulation,2020,141(9):e139-e596. [5] MAHADI HASSAN M T I K,MAHMUD.Cardiac Function Assessment By Echocardiography In Ischemic Stroke Non Hemorrhagic Cerebral Infarction[J].Haya Saudi J Life Sci,2022. [6] 和雪改,谢万木,万钧,等.右心声学造影检测肺动脉高压患者右向左分流的价值[J].中华医学杂志,2020,100(22):1715-1719. [7] 心衰中心心肌病专家委员会中国医师协会心血管内科医师分会心力衰竭学组.左心室肥厚诊断和治疗临床路径中国专家共识2023[J].中国循环杂志2024年1月第39卷第1期,2023. [8] 崔晓通,周京敏,徐亚妹,等.左心室肥厚诊断与治疗(复旦中山规范)[J].上海医学,2024,47(02):65-73. [9] 美国超声心动图协会(ASE)成人右心超声心动图诊断指南获欧洲心脏病协会欧洲超声心动图学会和加拿大超声心动图协会支持[J]. [10] OGAMA N,SAKURAI T,NAKAI T,et al.Impact of frontal white matter hyperintensity on instrumental activities of daily living in elderly women with Alzheimer disease and amnestic mild cognitive impairment[J].PLOS ONE,2017,12(3):e172484. [11] KRUYER A,SOPLOP N,STRICKLAND S,et al.Chronic Hypertension Leads to Neurodegeneration in the TgSwDI Mouse Model of Alzheimer’s Disease[J].Hypertension,2015,66(1):175-182. [12] THACKER E L,MCKNIGHT B,PSATY B M,et al.Atrial fibrillation and cognitive decline:A longitudinal cohort study[J]. Neurology,2013,81(2):119-125. [13] RAJENDIRAN K S,ANANTHANARAYANAN R H,SATHEESH S,et al.Elevated levels of serum sialic acid and high-sensitivity C-reactive protein:markers of systemic inflammation in patients with chronic heart failure[J].Br J Biomed Sci,2014,71(1):29-32. [14] TURK M,ZALETEL M,PRETNAR-OBLAK J.Ratio between carotid artery stiffness and blood flow-a new ultrasound index of ischemic leukoaraiosis[J].Clin Interv Aging,2016,11:65-71. [15] MURAMATSU T,MORISHIMA A,KATOH H,et al.[Study of left ventricular function in cerebral thrombosis with pulsed Doppler echocardiography][J].Nihon Ika Daigaku Zasshi,1994,61(1):36-46. [16] MCAREAVEY D,VIDAL J,ASPELUND T,et al.Correlation of Echocardiographic Findings With Cerebral Infarction in Elderly Adults[J].Stroke,2010,41(10):2223-2228. [17] 王欣,张媛,赵文淑,等.左心房内径､左心房内径指数在非瓣膜性心房颤动并发缺血性脑卒中诊断中的应用[J].山东医药, 2018,58(23):63-66. [18] CHILUKURI K,MAYER S A,SCHERR D,et al.Transoesophageal echocardiography predictors of periprocedural cerebrovascular accident in patients undergoing catheter ablation of atrial fibrillation[J].Europace,2010,12(11):1543-1549. [19] YAGHI S,KAMEL H,ELKIND M S V.Atrial cardiopathy:a mechanism of cryptogenic stroke[J].Expert Review of Cardiovascular Therapy,2017,15(8):591-599. [20] HERMIDA J,LOPEZ F L,MONTES R,et al.Usefulness of High-Sensitivity C-Reactive Protein to Predict Mortality in Patients With Atrial Fibrillation(from the Atherosclerosis Risk In Communities[ARIC]Study)[J].The American Journal of Cardiology,2012,109(1):95-99. [21] KIM Y D,CHA M J,KIM J,et al.Increases in Cerebral Atherosclerosis According to CHADS2 Scores in Patients With Stroke With Nonvalvular Atrial Fibrillation[J].Stroke,2011,42(4):930-934. [22] NAESS H,WAJE-ANDREASSEN U,THOMASSEN L.Persistent Atrial Fibrillation Is Associated with Worse Prognosis Than Paroxysmal Atrial Fibrillation in Acute Cerebral Infarction[J].ISRN Cardiology,2012,2012:1-4. [23] TSANG T S B M E B.Left atrial volume important risk marker of incident atrialfibrillation in 1655 older men and women[J].Mayo Clin Proc,2001. [24] SHAIKH Q,AHMED B,AHMED M,et al.Left atrial volumes and associated stroke subtypes[J].BMC Neurol,2013,13:149. [25] BOLDT A.Fibrosis in left atrial tissue of patients with atrial fibrillation with and without underlying mitral valve disease[J].Heart, 2004,90(4):400-405. [26] WU N,CHEN X,CAI T,et al.Association of Inflammatory and Hemostatic Markers With Stroke and Thromboembolic Events in Atrial Fibrillation:A Systematic Review and Meta-analysis[J].Canadian Journal of Cardiology,2015,31(3):278-286. [27] 姜娜娜,高志广,任国成,等.心房颤动患者左心房大小与缺血性脑卒中相关性分析[J].中国医药科学,2016,6(24):175-177,192. [28] BEINART R,HEIST E K,NEWELL J B,et al.Left Atrial Appendage Dimensions Predict the Risk of Stroke/TIA in Patients With Atrial Fibrillation[J].Journal of Cardiovascular Electrophysiology,2011,22(1):10-15. [29] KHURRAM I M M,DEWIRE J B,MAGER M R R M,et al.Relationship between left atrial appendage morphology and stroke in patients with atrial fibrillation[J].Heart rhythm,2013,10(12):1843-1849. [30] 李莹,杨萍.左房大小的影响因素及其临床意义[J].心血管病学进展,2008,29(2):235-238. [31] 叶天新,张翠,杨波.炎症反应与心房颤动的研究进展[J].中国心血管病研究,2019,17(5):385-389. [32] 王炎.心房颤动只需要控制心率吗?[J].内科急危重症杂志,2018,24(6):441-443. [33] MONTALVO M,TADI P,MERKLER A,et al.PR Interval Prolongation and Cryptogenic Stroke:A Multicenter Retrospective Study[J]. Journal of Stroke and Cerebrovascular Diseases,2017,26(10):2416-2420. [34] 廖丽红,刘甲兴,傅懋林.隐源性脑卒中合并阵发性心房颤动病人P波最大时限和P波离散度的临床意义[J].中西医结合心脑血管病杂志,2022,20(24):4588-4591. [35] 曹燕飞.老年冠状动脉狭窄与脑血管狭窄的临床关联研究[J].中国实用医药,2016,11(12):84-85. [36] BERGER M,NASEEM K M.Oxidised Low-Density Lipoprotein-Induced Platelet Hyperactivity—Receptors and Signalling Mechanisms[J].International Journal of Molecular Sciences,2022,23(16):9199. [37] ANTMAN E M,ANBE D T,ARMSTRONG P W,et al.ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction—Executive Summary[J].Circulation,2004,110(5):588-636. [38] CAMM A J,KIRCHHOF P,LIP G Y H,et al.Guidelines for the management of atrial fibrillation:The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology(ESC)[J].European Heart Journal,2010,31(19):2369-2429. [39] CARSON J A S,LICHTENSTEIN A H,ANDERSON C A M,et al.Dietary Cholesterol and Cardiovascular Risk:A Science Advisory From the American Heart Association[J].Circulation,2020,141(3). [40] GULATI A M U K J.Cerebral hypoperfusion in heart failure:Pathophysiology and clinical implications.[J].2018;39(8):1303-1310.. [41] WANG Y L X Z L.Impact of New York Heart Association functional class on stroke risk in coronary artery disease:A nationwide cohort study.[J].Stroke.2020;51(12):3654-3661., [42] HAMMILL BG E A.Left ventricular ejection fraction and risk of stroke in patients with heart failure and sinus rhythm.[J].2013;61(15):1571-1577. [43] MANN DL E A.Echocardiographic predictors of stroke in chronic heart failure:The SOLVD study.[J].Circulation,1997;96(12):4217-4223. [44] NAGUEH SF E A.American Society of Echocardiography consensus statement on the role of echocardiography in heart failure with preserved ejection fraction.[J].J Am Soc Echocardiogr.201629(1):1-19.

点击下载PDF