The Relationship Between Carotid Atherosclerosis And Ischemic Stroke With Atrial Fibrillation:a Clinical Study

Objective:To investigate whether carotid atherosclerosis is the risk factor for ischemic stroke in patients with non-valvular atrial fibrillation（NVAF）.To improve clinicians’attention to the risk of non-cardiac embolism in atrial fibrillation and provide the basis for risk stratification of ischemic stroke in patients with atrial fibrillation.Methods:A case-control study was conducted to collect 194 patients with atrial fibrillation who were hospitalized in the Second Hospital of Lanzhou University and met the inclusion and exclusion criteria,and 138 patients with atrial fibrillation complicated with ischemic stroke.They were divided into the atrial fibrillation group（n=194 cases）and the stroke group（n=138 cases）.SPSS 26.0 statistical software was used to analyze the differences in basic information,laboratory data,cardiac color doppler ultrasound,and carotid atherosclerosis indexes between the two groups.Taking 332 patients with atrial fibrillation as research objects,with or without stroke as a dependent variable,the correlation between carotid atherosclerosis index and ischemic stroke in atrial fibrillation was analyzed by multivariate logistic regression.In addition,according to whether patients have carotid intima-media thickening,332patients with atrial fibrillation were divided into the CIMT group（n=236）and the non-CIMT group（n=96）.The general data and clinical data of the two groups were compared to further evaluate the risk factors of carotid intima-media thickening in patients with atrial fibrillation.Results:1.The proportion of carotid intima-media thickening,carotid plaque,stable plaque,unstable plaque,and ulcerative plaque in stroke group was higher than that in atrial fibrillation group（77.5%vs 66.5%,70.3%vs 55.7%,11.6%vs 10.8%,58.7%vs 44.8%,64.5%vs 43.5%）.The plaque area of the stroke group was larger than that of the atrial fibrillation group（z=-3.532,P<0.001）,and the proportions of multiple plaques（c²=16.252,P<0.001）were significantly higher than atrial fibrillation group（P<0.05）.There was no significant difference in plaque location and carotid stenosis<50%between the atrial fibrillation group and stroke group（P>0.05）.2.Taking 332 patients with atrial fibrillation as the research object,further Logistic regression analysis showed that after adjusting the variables with statistical significance in univariate analysis,diabetes[OR=3.820,95%CI（1.800,8.090）,P≤0.001],history of previous ischemic stroke[OR=2.930,95%CI（1.200,7.170）,P=0.019],carotid intima-media thickening[OR=1.739,95%CI（1.056,2.864）,P=0.03],carotid artery plaque[OR=1.884,95%CI（1.187,2.991）,P=0.007],multiple plaques[OR=2.958,95%CI（1.700,5.147）,P<0.001],ulcerative plaques[OR=3.010,95%CI（1.277,7.097）,P=0.012]were risk factors for ischemic stroke in patients with atrial fibrillation.The risk of ischemic stroke in patients with carotid intima-media thickening[OR=1.739,95%CI（1.056,2.864）,P=0.03],carotid artery plaque[OR=1.884,95%CI（1.187,2.991）,P=0.007],multiple plaques[OR=2.958,95%CI（1.700,5.147）,P<0.001],ulcerative plaques[OR=3.010,95%CI（1.277,7.097）,P=0.012]was 1.739,1.884,1.953,2.958 and 3.010 times higher than that in patients without carotid atherosclerosis.3.The age,persistent atrial fibrillation ratio,and CHA₂DS₂-VASc score of the CIMT group were higher than those of the control group,and the percentage of heart failure history,previous ischemic stroke history,and hypertension history were also higher than those of the control group,with statistical significance（P<0.05）.The RDW-SD,RDW-CV,uric acid,carbon dioxide binding rate,and fibrinogen in the CIMT group were higher than those in the non-CIMT group（P<0.05）.4.Multivariate Logistic regression analysis showed that age[OR=1.084,95%CI（1.034,1.136）,P=0.001],persistent atrial fibrillation[OR=3.009,95%CI（1.613,5.614）,P=0.001],and uric acid[OR=1.005,95%CI（1.002,1.008）,P=0.004]are independent risk factors for carotid intima-media thickening in patients with atrial fibrillation.Conclusion:1.Patients with non-valvular atrial fibrillation with ischemic stroke have a higher incidence of carotid atherosclerosis（including carotid intima-media thickening,carotid plaque,unstable plaque,ulcerative plaque,multiple plaque）which may increase the risk of ischemic stroke in patients with atrial fibrillation.2.The patients with atrial fibrillation complicated with carotid intima-media thickening had a higher CHA₂DS₂-VASc and age.3.The type of atrial fibrillation and the level of serum uric acid may be related to carotid intima-media thickening in patients with atrial fibrillation.