Department of Geriatrics and Metabolic Diseases, Second University of Naples, Piazza Miraglia 2, Naples, Italy.
J Am Coll Cardiol. 2013 Aug 6;62(6):525-30. doi: 10.1016/j.jacc.2013.02.091. Epub 2013 May 15.
This study evaluated whether subclinical episodes of atrial fibrillation (AF) were associated with an increased risk of silent cerebral infarct (SCI) and stroke in diabetic patients younger than 60 years who did not have other clinical evidence of AF and cerebrovascular disease at baseline.
In type 2 diabetic patients, one-fourth of strokes are of unknown cause, and subclinical episodes of AF may be a common etiologic factor.
A total of 464 type 2 diabetic patients younger than 60 years were included in a longitudinal observational study and matched to patients without diabetes. Patients underwent 48-h electrocardiographic Holter monitoring quarterly to detect brief subclinical episodes of AF (duration of AF <48 h) and were followed up for 37 months. The outcomes were SCI, assessed by magnetic resonance imaging of the brain, and stroke events during the follow-up period.
The prevalence of subclinical episodes of AF was significantly greater among patients with diabetes compared with matched healthy subjects (11% vs. 1.6%, p < 0.0001). During an average duration of 37 months, 43 stroke events occurred in the diabetic population and no events occurred in healthy subjects. Diabetic patients with silent episodes of AF (n = 176) had a higher baseline prevalence of SCI (61% vs. 29%; p < 0.01) and a higher number of stroke events (17.3% vs. 5.9%; p < 0.01) during the follow-up period than the other patients (n = 288). An episode of silent AF was an independent determinant of SCI (odds ratio: 4.441; p < 0.001; confidence interval: 2.42 to 8.16) and an independent predictor of the occurrence of stroke in diabetic patients (hazard ratio: 4.6; p < 0.01; confidence interval: 2.7 to 9.1).
Subclinical episodes of AF occurred frequently in type 2 diabetic patients and were associated with a significantly increased risk of SCI and stroke.
本研究旨在评估亚临床房颤（AF）发作是否与无其他临床 AF 和脑血管疾病证据的年轻（<60 岁）2 型糖尿病患者发生无症状性脑梗死（SCI）和卒中风险增加相关。
在 2 型糖尿病患者中，有四分之一的卒中病因不明，亚临床 AF 发作可能是一个常见的病因因素。
共有 464 名年龄<60 岁的 2 型糖尿病患者纳入一项纵向观察性研究，并与非糖尿病患者相匹配。患者每季度接受 48 小时心电图动态 Holter 监测以检测短暂的亚临床 AF 发作（AF 持续时间<48 小时），并随访 37 个月。主要终点为 SCI，通过脑磁共振成像评估，次要终点为随访期间发生的卒中事件。
与匹配的健康受试者相比，糖尿病患者亚临床 AF 发作的患病率显著更高（11%比 1.6%，p<0.0001）。在平均 37 个月的随访期间，糖尿病患者中发生了 43 例卒中事件，而健康受试者中无事件发生。伴有无症状性 AF 发作的糖尿病患者（n=176）在基线时 SCI 的患病率（61%比 29%；p<0.01）和随访期间的卒中事件发生率（17.3%比 5.9%；p<0.01）均高于其他患者（n=288）。无症状性 AF 发作是 SCI 的独立决定因素（比值比：4.441；p<0.001；95%置信区间：2.42 至 8.16），也是糖尿病患者发生卒中的独立预测因素（风险比：4.6；p<0.01；95%置信区间：2.7 至 9.1）。
亚临床 AF 发作在 2 型糖尿病患者中较为常见，与 SCI 和卒中风险显著增加相关。
