Ward Frank, McGovern Rory, Cotter Paul E
Department of Geriatric and Stroke Medicine, St Luke's Hospital, Kilkenny, Ireland.
Department of Geriatric and Stroke Medicine, St Luke's Hospital, Kilkenny, Ireland.
J Stroke Cerebrovasc Dis. 2015 Jan;24(1):66-72. doi: 10.1016/j.jstrokecerebrovasdis.2014.07.038. Epub 2014 Oct 18.
Prolonged cardiac monitoring detects higher rates of atrial fibrillation (AF) in ischemic stroke and transient ischemic attack (TIA) but is costly and has practical implications. The use of admission troponin-I (TnI) level to identify patients at high risk of delayed AF detection was investigated.
Consecutive ischemic stroke and TIA cases presenting to our institute over a 13-month period were identified from the Irish Stroke and TIA Register. Electronic databases and case notes were examined. "Delayed" AF was diagnosed after a sinus rhythm admission electrocardiogram and no documented history. Group comparisons were made by AF status. The association between TnI and AF was investigated using a multivariate regression model.
A total of 185 cases (130 ischemic stroke) were analyzed. Mean age (standard deviation) was 73.3 (13.9) years, 47% female. Sixty-two cases (33.5%) had AF. The first documented presentation of AF was found in 21 cases, on admission electrocardiogram (n = 11) or inpatient telemetry (delayed, n = 10). TnI was higher in those with delayed AF than in those without AF (W = 194; P = .036). A higher proportion of those with an elevated TnI (30%) than those with a normal TnI (6.1%) had delayed diagnosis of AF (χ(2) = 6.41, P = .011). Having an abnormal TnI was a significant independent predictor of delayed AF detection (odds ratio, 5.8; P = .037).
TnI elevation is associated with a higher likelihood of subsequent AF diagnosis. Identification of these higher risk stroke and TIA cases for more intensive cardiac monitoring may improve stroke secondary prevention practices.
长时间心脏监测可检测出缺血性中风和短暂性脑缺血发作（TIA）患者中更高的房颤（AF）发生率，但成本高昂且具有实际影响。本研究旨在探讨利用入院时肌钙蛋白I（TnI）水平来识别延迟房颤检测高危患者。
从爱尔兰中风和TIA登记册中识别出在13个月期间连续就诊于我院的缺血性中风和TIA病例。检查电子数据库和病例记录。“延迟性”房颤在入院时窦性心律心电图且无房颤病史记录后被诊断。按房颤状态进行组间比较。使用多变量回归模型研究TnI与房颤之间的关联。
共分析了185例病例（130例缺血性中风）。平均年龄（标准差）为73.3（13.9）岁，47%为女性。62例（33.5%）有房颤。21例首次记录到房颤，其中入院心电图时发现11例，住院遥测时发现（延迟性，10例）。延迟性房颤患者的TnI高于无房颤患者（W = 194；P = 0.036）。TnI升高的患者中延迟诊断房颤的比例（30%）高于TnI正常的患者（6.1%）（χ² = 6.41，P = 0.011）。TnI异常是延迟房颤检测的显著独立预测因素（比值比，5.8；P = 0.037）。
TnI升高与随后房颤诊断的可能性增加相关。识别这些高危中风和TIA病例以进行更强化的心脏监测可能会改善中风二级预防措施。
