心房颤动（房颤）是脑卒中的重要危险因素。即使通过抗凝治疗进行二级预防，房颤患者的年化脑卒中复发率仍高达3.2%～6.5%。传统的CHA2DS2-VASc评分系统是基于临床因素进行风险分层，难以反映动态心脏结构重塑或亚临床脑血管损伤。本文阐述了神经影像学（如隐匿性脑梗死、脑微出血、白质高信号）和超声心动图（如左心房结构、左心房应变、左心耳形态、左心耳自发回声对比、左心耳排空速度等）应用于房颤相关脑卒中复发风险评估的研究进展，以期优化传统评分，从而实现更精准的风险分层。

Atrial fibrillation (AF) is a critical risk factor for stroke. Despite secondary prevention with anticoagulant therapy, the annualized risk of stroke recurrence in patients with AF remains substantial, ranging from 3.2% to 6.5%. The traditional CHA2DS2-VASc scoring system, which is based on clinical factors for risk stratification, fails to adequately reflect dynamic cardiac structural remodeling or subclinical cerebrovascular injury. This paper reviews recent advances in neuroimaging (covert brain infarction, cerebral microbleeds and white matter hyperintensities) and echocardiography (left atrial structure, left atrial strain, left atrial appendage morphology, left atrial appendage spontaneous echo contrast and left atrial appendage emptying velocity) for risk assessment of stroke recurrence in patients with atrial fibrillation, which aims to optimize the traditional scoring system for more precise risk stratification.