Stroke Unit, Saint Roch Hospital, University Hospital Center of Nice, Nice, France.
J Stroke Cerebrovasc Dis. 2013 Oct;22(7):e103-10. doi: 10.1016/j.jstrokecerebrovasdis.2012.08.010. Epub 2012 Sep 23.
Detection of new atrial fibrillation (AF) after ischemic stroke is challenging. The aim of the TARGET-AF study was to identify relevant markers for ruling out delayed AF in stroke patients. Early and prolonged Holter electrocardiography (ECG) monitoring during hospitalization was performed systematically in consecutive acute stroke patients naive to AF (no history of AF or no AF on baseline ECG). All clinical and paraclinical data for routine etiologic assessment were collected. The diagnostic value of all parameters significantly associated with AF was assessed by comparison of area under the receiver operating characteristic curve (AUC). Of the 300 stroke patients enrolled (mean age, 62.5 ± 15.5 years; sex ratio: 1.7; mean National Institutes of Health Stroke Scale score, 7.1 ± 7.9, median duration of Holter ECG monitoring, 6.8 days), 52 (17.3%) had newly diagnosed AF. Parameters significantly associated with AF were classified by increasing AUC: anterior circulation localization (AUC, 0.604; 95% confidence interval [CI], 0.546-0.660), P-wave initial force (AUC, 0.608; 95% CI, 0.545-0.669), left atrial dilatation (AUC, 0.657; 95% CI, 0.600-0.711), National Institutes of Health Stroke Scale score (AUC, 0.667; 95% CI, 0.611-0.720), sex (AUC, 0.683; 95% CI, 0.627-0.736), age (AUC, 0.755; 95% CI, 0.707-0.797), CHA2DS2-VASc score (AUC, 0.796; 95% CI, 0.746-0.841), STAF (score for the targeting of AF) score (AUC, 0.842; 95% CI, 0.796-0.882), and plasma brain natriuretic peptide (BNP) level (AUC, 0.868; 95% CI, 0.825-0.904). The use of all parameters combined (AUC, 0.910; 95% CI, 0.872-0.940) was not significantly more efficient in diagnosing AF than BNP alone (P = .248). At the Youden plot, the diagnostic properties for BNP >131 pg/mL were sensitivity, 98.1% (95% CI, 89.7-99.7); specificity, 71.4% (95% CI, 65.3-76.9); and negative predictive value, 99.4% (95% CI, 96.9-99.9). Our data indicate that a BNP level ≤ 131 pg/mL might rule out delayed AF in stroke survivors and could be included in algorithms for AF detection.
检测缺血性脑卒中后新发心房颤动（AF）具有挑战性。TARGET-AF 研究的目的是确定相关标志物，以排除卒中患者中延迟性 AF。连续入组无 AF 病史（基线心电图无 AF 或无 AF 记录）的急性卒中患者，在住院期间系统地进行早期和延长的动态心电图监测。收集所有用于常规病因评估的临床和辅助检查数据。通过比较受试者工作特征曲线下面积（AUC）评估所有与 AF 显著相关的参数的诊断价值。300 例卒中患者（平均年龄 62.5±15.5 岁；性别比 1.7；平均 NIHSS 评分 7.1±7.9，动态心电图监测中位时间 6.8 天）中，52 例（17.3%）新诊断为 AF。按 AUC 由高到低依次分类与 AF 显著相关的参数：前循环定位（AUC 0.604；95%置信区间 [CI]，0.546-0.660）、P 波初始力（AUC 0.608；95%CI，0.545-0.669）、左房扩大（AUC 0.657；95%CI，0.600-0.711）、NIHSS 评分（AUC 0.667；95%CI，0.611-0.720）、性别（AUC 0.683；95%CI，0.627-0.736）、年龄（AUC 0.755；95%CI，0.707-0.797）、CHA2DS2-VASc 评分（AUC 0.796；95%CI，0.746-0.841）、STAF 评分（AF 靶向评分）（AUC 0.842；95%CI，0.796-0.882）和血浆脑钠肽（BNP）水平（AUC 0.868；95%CI，0.825-0.904）。与单独使用 BNP 相比，联合使用所有参数（AUC 0.910；95%CI，0.872-0.940）诊断 AF 的效率并无显著提高（P=.248）。在 Youden 分析中，BNP＞131pg/ml 的诊断性能为：敏感性 98.1%（95%CI，89.7-99.7）、特异性 71.4%（95%CI，65.3-76.9）和阴性预测值 99.4%（95%CI，96.9-99.9）。我们的数据表明，BNP 水平≤131pg/ml 可能排除卒中幸存者中延迟性 AF，可被纳入 AF 检测算法。
