References

clinmed

Клиническая медицина

Clinical Medicine (Russian Journal)

0023-21492412-1339

ООО «Медицинское информационное агентство»

10.30629/0023-2149-2023-101-9-10-441-448

clinmed-627

Research Article

ОБЗОРЫ И ЛЕКЦИИ

REVIEWS AND LECTURES

Анатомические факторы внутрисердечного тромбообразования в патогенезе кардиоэмболического инсульта

Anatomical factors of intracavitary thrombus formation in the pathogenesis of cardioembolic stroke

https://orcid.org/0000-0002-8552-6727

Милюков

В. Е.

Milyukov

V. E.

Милюков Владимир Ефимович — д-р мед. наук, профессор, профессор кафедры анатомии человека лечебного факультета

117997, Москва

Milyukov Vladimir Е.

117997, Moscow

https://orcid.org/0000-0001-8445-3688

Брюханов

В. А.

Bryukhanov

V. A.

Брюханов Валерий Александрович — студент Института клинической медицины им. Н.В. Склифосовского

119991, Москва

Bryukhanov Valery A.

119991, Moscow

bryuhanov02@mail.ru

https://orcid.org/0000-0003-2190-6648

Нгуен

К. К.

Nguyen

С. С.

Нгуен Као Кыонг — канд. мед. наук, декан факультета фармако-медсестринского дела

670000, Далат

Nguyen Cao Cuong

670000, Da Lat City

ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииРоссияPirogov Russian National Research Medical University (Pirogov Medical University) of the Ministry of Health of RussiaRussian Federation

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова Минздрава России (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University)Russian Federation

Университет им. ЙерсенаВьетнамYersin University of Da LatViet Nam

2023

12112023

1019-10441448

2023

Милюков В.Е., Брюханов В.А., Нгуен К.К.

Milyukov V.E., Bryukhanov V.A., Nguyen С.С.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.clinmedjournal.com/jour/article/view/627

Кардиоэмболический инсульт, как и другие виды острого нарушения мозгового кровотока, является общемировой приоритетной медико-социальной проблемой. В настоящем обзоре проанализирована роль анатомических факторов, которые наряду с другими факторами тромбообразования в полостях сердца могут представлять собой важное и при этом недостаточно изученное звено патогенеза этого заболевания.

Cardioembolic stroke, like other types of acute cerebrovascular disorders, is a global priority medical and social problem. This review analyzes the role of anatomical factors, which, along with other factors of thrombus formation in the heart chambers, may represent an important and yet insufficiently studied link in the pathogenesis of this disease.

кардиоэмболический инсульттромбообразованиеанатомия сердца

cardioembolic strokethrombus formationheart anatomy

References1

Virani S.S. et al. Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation. 2020;141(9):e139–e596. DOI: 10.1161/CIR.0000000000000757

Donkor E.S. Stroke in the 21st century: a snapshot of the burden, epidemiology, and quality of life. Stroke Res. Treat. 2018;2018:3238165. Published 2018 Nov 27. DOI: 10.1155/2018/3238165

GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021;20(10):795–820. DOI: 10.1016/S1474-4422(21)00252-0

Ма-Ван-дэ А.Ю., Витковский Ю.А., Ширшов Ю.А. Эпиде миологические аспекты и факторы риска развития ишемического инсульта. Забайкальский медицинский вестник. 2022;2:41–52.

Ma-Van-de A.Yu., Vitkovskij Yu.A., Shirshov Yu.A. Epidemiological aspects and risk factors for ischemic stroke. Zabajkal’skij medicinskij vestnik. 2022;2:41–52. (In Russian). DOI: 10.52485/19986173_2022_2_41

Singh R.J., Chen S., Ganesh A., Hill M.D. Long-term neurological, vascular, and mortality outcomes after stroke. Int. J. Stroke. 2018;13(8):787-796. DOI: 10.1177/1747493018798526

Бизюк А.П., Барич И.В. Особенности полушарной латерализа ции понятийного и образного мышления у больных с право- и левосторонней локализацией очага ишемического инсульта. Евразийский союз ученых. Серия: педагогические, психологические и философские науки. 2021;5(86):54–62.

Bizyuk A.P., Barich I.V. Features of hemispheric lateralization of conceptual and fi gurative thinking in patients with right- and left-sided localization of the focus of ischemic stroke. Eurasian Union of Scientists. Evrazijskij soyuz uchenyh. Seriya: pedagogicheskie, psihologicheskie i fi losofskie nauki. 2021;5(86):54–62. (In Russian). DOI: 10.31618/ESU.2413-9335.2021.1.86.1369.

Katan M., Luft A. Global burden of stroke. Semin. Neurol. 2018;38(2):208–211. DOI: 10.1055/s-0038-1649503

Яхно H.H, Виленский Б.С. Инсульт как медикосоциальная проблема. Русский медицинский журнал. 2005;13(12):807–15.

Yahno H.H., Vilenskij B.S. Stroke as a medical and social problem. Russian medical journal. 2005;13(12):807–15. (In Russian).

Kleindorfer D.O., Towfi ghi A., Chaturvedi S. et al. Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association [published correction appears in Stroke. 2021;52(7):e483–e484]. Stroke. 2021;52(7):e364–e467. DOI: 10.1161/STR.0000000000000375

Kleindorfer D.O., Towfi ghi A., Chaturvedi S. et al. Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association published correction appears in Stroke. 2021;52(7):e483–e484. Stroke. 2021;52(7):e364–e467. DOI: 10.1161/STR.0000000000000375

Topcuoglu M.A., Liu L., Kim D.E., Gurol M.E. Updates on prevention of cardioembolic strokes. J. Stroke. 2018;20(2):180–196. DOI: 10.5853/jos.2018.00780

Arboix A., Alió J. Cardioembolic stroke: clinical features, specifi c cardiac disorders and prognosis. Current cardiology reviews. 2010;6(3):150–61. DOI: 10.2174/157340310791658730

Hooman K., Healey J. Cardioembolic stroke. Circulation research. 2017;120(3):514–526. DOI: 10.1161/CIRCRESAHA.116.308407

Wolf P.A. et al. Atrial fi brillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22(8):983–8. DOI: 10.1161/01.str.22.8.983

Friberg L., Rosenqvist M., Lindgren A., Terént A., Norrving B., Asplund K. High prevalence of atrial fi brillation among patients with ischemic stroke. Stroke. 2014;(45):2599–605. DOI: 10.1161/STROKEAHA.114.006070

Babkair L.A. Cardioembolic stroke: a case study. Critical care nurse. 2017;37(1):27–39. DOI: 10.4037/ccn2017127

Arboix A., Alio J. Acute cardioembolic cerebral infarction: answers to clinical questions. Current cardiology reviews. 2012;8(1):54–67. DOI: 10.2174/157340312801215791

Ding W.Y., Gupta Dh., Lip G.Y.H. Atrial fi brillation and the prothrombotic state: revisiting Virchow’s triad in 2020. Heart (Bri tish Cardiac Society). 2020;106(19):1463–1468. DOI: 10.1136/heartjnl-2020-316977

Ntaios G., Hart R.G. Embolic stroke. Circulation. 2017;136(25):2403– 2405. DOI: 10.1161/CIRCULATIONAHA.117.030509

Pepi M., Evangelista A., Nihoyannopoulos P. et al. Recommendations for echocardiography use in the diagnosis and management of cardiac sources of embolism: European Association of Echocardiography (EAE) (a registered branch of the ESC). Eur. J. Echocardiogr. 2010;11(6):461–476. DOI: 10.1093/ejechocard/jeq045

Di Minno M.N.D., Ambrosino P., Russo A.D., Casella M., Tremoli E., Tondo C. Prevalence of left atrial thrombus in patients with non-valvular atrial fi brillation. A systematic review and meta-analysis of the literature. Thrombosis and haemostasis. 2016;115(3):663– 77. DOI: 10.1160/TH15-07-0532

Abe Y., Asakura T., Gotou J., Iwai M., Watanabe Y., Sando M., Ishikawa S., Nagata K., Saito T., Maehara K., Maruyama Y. Prediction of embolism in atrial fi brillation: classifi cation of left atrial thrombi by transesophageal echocardiography. Jpn. Circ. J. 2000;64(6):411– 415. DOI: 10.1253/jcj.64.411

Blackshear J.L., Odell J.A. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fi brillation. Ann. Thorac. Surg. 1996;61(2):755–759. DOI: 10.1016/0003-4975(95)00887-X

Cresti A., García-Fernández M.A., Sievert H. et al. Prevalence of extra-appendage thrombosis in non-valvular atrial fi brillation and atrial fl utter in patients undergoing cardioversion: a large transoesophageal echo study. EuroIntervention. 2019;15(3):e225–e230. DOI: 10.4244/EIJ-D-19-00128

Beigel R., Wunderlich N.C., Ho S.Y., Arsanjani R., Siegel R.J. The left atrial appendage: anatomy, function, and noninvasive evaluation. JACC Cardiovasc. Imaging. 2014;7(12):1251–1265. DOI: 10.1016/j.jcmg.2014.08.009

Hensey M., O’Neill L., Mahon C., Keane S., Fabre A., Keane D. A Review of the anatomical and histological attributes of the left atrial appendage with descriptive pathological examination of morphology and histology. J. Atr. Fibrillation. 2018;10(6):1650. DOI: 10.4022/jafib.1650

Kim Y.G., Shim J., Oh S.K., Lee K.N., Choi J.I., Kim Y.H. Electrical isolation of the left atrial appendage increases the risk of ischemic stroke and transient ischemic attack regardless of postisolation fl ow velocity. Heart Rhythm. 2018;15(12):1746–1753. DOI: 10.1016/j.hrthm.2018.09.012

Al-Saady N.M., Obel O.A., Camm A.J. Left atrial appendage: structure, function, and role in thromboembolism. Heart. 1999;82(5):547– 554. DOI: 10.1136/hrt.82.5.547

Di Biase L., Santangeli P., Anselmino M., Mohanty P., Salvetti I. et al. Does the left atrial appendage morphology correlate with the risk of stroke in patients with atrial fi brillation? Results from a multicenter study. J. Am.Coll. Cardiol. 2012;60(6):531–8. DOI: 10.1016/j.jacc.2012.04.032

Kosiuk J. , Nedios S., Kornej J., Koutalas E., Bertagnolli L. et al. Impact of left atrial appendage morphology on peri-interventional thromboembolic risk during catheter ablation of atrial fi brillation. Heart rhythm. 2014;11(9):1522–7. DOI:10.1016/j.hrthm.2014.05.022

Khurram I.M., Dewire J., Mager M., Maqbool F., Zimmerman S.L. et al. Relationship between left atrial appendage morphology and stroke in patients with atrial fi brillation. Heart rhythm. 2013;10(12):1843– 9. DOI: 10.1016/j.hrthm.2013.09.065

Khurram I.M., Dewire J., Mager M., Maqbool F., Zimmerman S.L. et al. Relationship between left atrial appendage morphology and stroke in patients with atrial fibrillation. Heart rhythm. 2013;10(12):1843– 9. DOI: 10.1016/j.hrthm.2013.09.065

Wu L., Liang E., Fan S., Zheng L., Du Zh. et al. Relation of left atrial appendage morphology determined by computed tomography to prior stroke or to increased risk of stroke in patients with atrial fibrillation. Am. J. Cardiol. 2019;123(8):1283–1286. DOI: 10.1016/j.amjcard.2019.01.024

Wu L., Liang E., Fan S., Zheng L., Du Zh. et al. Relation of left atrial appendage morphology determined by computed tomography to prior stroke or to increased risk of stroke in patients with atrial fi brillation. Am. J. Cardiol. 2019;123(8):1283–1286. DOI: 10.1016/j.amjcard.2019.01.024

Yaghi S., Chang A., Akiki R. et al. The left atrial appendage morphology is associated with embolic stroke subtypes using a simple classifi cation system: A proof of concept study. J. Cardiovasc. Comput. Tomogr. 2020;14(1):27–33. DOI: 10.1016/j.jcct.2019.04.005

He J., Fu Z., Yang L., Liu W., Tian Y. et al. The predictive value of a concise classifi cation of left atrial appendage morphology to thrombosis in non-valvular atrial fi brillation patients. Clin. Cardiol. 2020;43(7):789–795. DOI: 10.1002/clc.23381

Słodowska K., Szczepanek E., Dudkiewicz D. et al. Morphology of the left atrial appendage: introduction of a new simplifi ed shapebased classifi cation system. Heart Lung Circ. 2021;30(7):1014– 1022. DOI: 10.1016/j.hlc.2020.12.006

Smit J.M., Simon J., El Mahdiui M. et al. Anatomical characteristics of the left atrium and left atrial appendage in relation to the risk of stroke in patients with versus without atrial fi brillation. Circ. Arrhythm. Electrophysiol. 2021;14(8):e009777. DOI: 10.1161/CIRCEP.121.009777

Patti G., Pengo V., Marcucci R. et al. The left atrial appendage: from embryology to prevention of thromboembolism. Eur. Heart J. 2017;38(12):877–887. DOI: 10.1093/eurheartj/ehw159

Malik R., Alyeshmerni D.M., Wang Z. et al. Prevalence and predictors of left atrial thrombus in patients with atrial fi brillation: is transesophageal echocardiography necessary before cardioversion? Cardiovasc. Revasc. Med. 2015;16(1):12–14. DOI: 10.1016/j.carrev.2014.12.009

Chen L., Xu C., Chen W., Zhang C. Left atrial appendage orifi ce area and morphology is closely associated with fl ow velocity in patients with nonvalvular atrial fi brillation. BMC Cardiovasc. Disord. 2021;21(1):442. Published 2021 Sep 16. DOI: 10.1186/s12872-021-02242-9

Lee J.M., Seo J., Uhm J.S. et al. Why Is Left Atrial Appendage Morphology Related to Strokes? An Analysis of the Flow Velocity and Orifi ce Size of the Left Atrial Appendage. J. Cardiovasc. Electrophysiol. 2015;26(9):922–927. DOI: 10.1111/jce.12710

Lee J.M., Kim J.B., Uhm J.S., Pak H.N., Lee M.H., Joung B. Additional value of left atrial appendage geometry and hemodynamics when considering anticoagulation strategy in patients with atrial fi brillation with low CHA2DS2-VASc scores. Heart Rhythm. 2017;14(9):1297–1301. DOI: 10.1016/j.hrthm.2017.05.034

Fukushima K., Fukushima N., Kato K. et al. Correlation between left atrial appendage morphology and fl ow velocity in patients with paroxysmal atrial fi brillation. Eur. Heart J. Cardiovasc. Imaging. 2016;17(1):59–66. DOI: 10.1093/ehjci/jev117

Masci A., Barone L., Dedè L. et al. The Impact of Left Atrium Appendage Morphology on Stroke Risk Assessment in Atrial Fibrillation: A Computational Fluid Dynamics Study. Front Physiol. 2019;9:1938. Published 2019 Jan 22. DOI:10.3389/fphys.2018.01938

Fang R., Li Y., Zhang Y., Chen Q., Liu Q., Li Z. Impact of left atrial appendage location on risk of thrombus formation in patients with atrial fi brillation. Biomech. Model Mechanobiol. 2021;20(4):1431– 1443. DOI: 10.1007/s10237-021-01454-4

Alinezhad L., Ghalichi F., Ahmadlouydarab M., Chenaghlou M. Left atrial appendage shape impacts on the left atrial fl ow hemodynamics: A numerical hypothesis generating study on two cases. Comput. Methods Programs Biomed. 2022;213:106506. DOI: 10.1016/j.cmpb.2021.106506

Lee Y., Park H.C., Lee Y., Kim S.G. Comparison of morphologic features and fl ow velocity of the left atrial appendage among patients with atrial fi brillation alone, transient ischemic attack, and cardioembolic stroke. Am. J. Cardiol. 2017;119(10):1596–1604. DOI: 10.1016/j.amjcard.2017.02.016

Wang F., Zhu M., Wang X. et al. Predictive value of left atrial appendage lobes on left atrial thrombus or spontaneous echo contrast in patients with non-valvular atrial fi brillation. BMC Cardiovasc. Disord. 2018;18(1):153. Published 2018 Jul 31. DOI: 10.1186/s12872-018-0889-y

Velangi P.S., Choo C., Chen K.A. et al. Long-term embolic outcomes after detection of left ventricular thrombus by late gadolinium enhancement cardiovascular magnetic resonance imaging: a matched cohort study. Circ. Cardiovasc. Imaging. 2019;12(11):e009723. DOI: 10.1161/CIRCIMAGING.119.009723

Saric M., Armour A.C., Arnaout M.S. et al. Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism. J. Am. Soc. Echocardiogr. 2016;29(1):1–42. DOI: 10.1016/j.echo.2015.09.011

Alkindi F., Hamada A.H., Hajar R. Cardiac thrombi in different clinical scenarios. Heart Views. 2013;14(3):101–105. DOI: 10.4103/1995-705X.125924.

Ram P., Shah M., Sirinvaravong N. et al. Left ventricular thrombosis in acute anterior myocardial infarction: Evaluation of hospital mortality, thromboembolism, and bleeding. Clin. Cardiol. 2018;41(10):1289–1296. DOI: 10.1002/clc.23039

Meurin P., Brandao Carreira V., Dumaine R. et al. Incidence, diagnostic methods, and evolution of left ventricular thrombus in patients with anterior myocardial infarction and low left ventricular ejection fraction: a prospective multicenter study. Am. Heart J. 2015;170(2):256–262. DOI: 10.1016/j.ahj.2015.04.029

Weinsaft J.W., Kim J., Medicherla C.B. et al. Echocardiographic Algorithm for Post-Myocardial Infarction LV Thrombus: A Gatekeeper for Thrombus Evaluation by Delayed Enhancement CMR. JACC Cardiovasc. Imaging. 2016;9(5):505–515. DOI: 10.1016/j.jcmg.2015.06.017

Oh J.K., Park J.H., Lee J.H., Kim J., Seong I.W. Shape and mobility of a left ventricular thrombus are predictors of thrombus resolution. Korean Circ. J. 2019;49(9):829–837. DOI: 10.4070/kcj.2018.0346

Garg P., van der Geest R.J., Swoboda P.P. et al. Left ventricular thrombus formation in myocardial infarction is associated with altered left ventricular blood fl ow energetics. Eur. Heart J. Cardiovasc. Imaging. 2019;20(1):108–117. DOI: 10.1093/ehjci/jey121

Sakakibara T., Suwa K., Ushio T. et al. Intra-left ventricular hemodynamics assessed with 4D fl ow magnetic resonance imaging in patients with left ventricular thrombus. Int. Heart J. 2021;62(6):1287– 1296. DOI:10.1536/ihj.20-792

Vedula V., Seo J.H., Lardo A.C. et al. Effect of trabeculae and papillary muscles on the hemodynamics of the left ventricle. Theor. Comput. Fluid Dyn. 2016;30:3–21. DOI: 10.1007/s00162-015-0349-6

Yamada T., Hayase T., Miyauchi S. et al., Numerical analysis of the effect of trabeculae carneae models on blood fl ow in a left ventricle model constructed from magnetic resonance images. Journal of Biomechanical Science and Engineering. 2018;13:00517–00597. DOI: 10.1299/jbse.17-00597

Miyauchi S., Yamada T., Hosoi K., Hayase T., Funamoto K. Numerical analysis of the blood fl ow in the left ventricle with internal structures: Effect of trabeculae carneae models and atrial fi brillation. AIP Adv. 2019;9:105209. DOI: 10.1063/1.5124730

Gannon M.P., Saba S.G., Hirsh B.J. et al. Three-dimensional echocardiography demonstrates a skewered left ventricular thrombus in a patient with a heart transplant. Echocardiography. 2018;35(12):2117– 2120. DOI: 10.1111/echo.14158

Чухловина М.Л., Алексеева Т.М., Ефремова Е.С. Этиологическая структура и коморбидность кардиоэмболического инсульта. Артериальная гипертензия. 2021;27(1):110–116.

Chukhlovina M.L., Alekseeva T.M., Efremova E.S. Etiological structure and comorbidity of cardioembolic stroke. Arterial’naya Gipertenziya. 2021;27(1):110–116. (In Russian). DOI: 10.18705/1607-419X-2021-27-1-110-116

The authors declare that there are no conflicts of interest present.