Pinho João, Braga Carlos Galvão, Rocha Sofia, Santos Ana Filipa, Gomes André, Cabreiro Ana, Magalhães Sónia, Ferreira Carla
Neurology Department, Hospital de Braga, Portugal.
Cardiology Department, Hospital de Braga, Braga, Portugal.
J Stroke Cerebrovasc Dis. 2015 Feb;24(2):507-10. doi: 10.1016/j.jstrokecerebrovasdis.2014.09.029. Epub 2014 Dec 18.
To characterize atrial ectopic activity in patients with cryptogenic ischemic stroke (CIS) or transient ischemic attack (TIA) and determine its prognostic significance.
Retrospective cohort study, in which 184 patients with CIS or TIA who had performed 24-hour Holter electrocardiogram were included. The median follow-up was 27.5 months. Baseline clinical and imagiologic characteristics, etiologic investigation results, and ischemic stroke and TIA recurrences information were collected. Number of atrial premature complexes (APCs) per hour was categorized as less than 10 APCs/hour, 10-30 APCs/hour, and more than 30 APCs/hour.
Most of the patients had less than 10 APCs/hour (82.6%), 8.2% had 10-30 APCs/hour, and 9.2% had more than 30 APCs/hour. Patients with more than 30 APCs/hour had a greater median left atrium diameter than patients with 30 APCs/hour or less (42 mm vs. 38 mm; 95% confidence interval [CI], .50-7.00; P = .003). Annual recurrence rate of CIS or TIA was 2.9% in patients with less than 10 APCs/hour, 11.0% in 10-30 APCs/hour, and 22.6% in more than 30 APCs/hour (P = .001). More than 30 APCs/hour were independently associated with recurrence risk in multivariate survival analysis (hazard ratio, 3.40; 95% CI, 1.12-10.32; P = .030).
In patients with CIS or TIA, frequent atrial ectopic activity (>30 APCs/h) was independently associated with increased risk of stroke or TIA recurrence. Further studies need to validate frequent atrial ectopic activity as a risk factor for recurrence in cryptogenic stroke and confirm its role as a predictor of occult atrial fibrillation.
明确隐源性缺血性卒中（CIS）或短暂性脑缺血发作（TIA）患者的房性异位活动特征，并确定其预后意义。
回顾性队列研究，纳入184例接受24小时动态心电图检查的CIS或TIA患者。中位随访时间为27.5个月。收集基线临床和影像学特征、病因学调查结果以及缺血性卒中和TIA复发信息。每小时房性早搏（APC）的数量分为每小时少于10次APC、每小时10 - 30次APC以及每小时多于30次APC。
大多数患者每小时APC少于10次（82.6%），8.2%的患者每小时有10 - 30次APC，9.2%的患者每小时多于30次APC。每小时多于30次APC的患者左心房直径中位数大于每小时30次APC及以下的患者（42毫米对38毫米；95%置信区间[CI]，0.50 - 7.00；P = 0.003）。每小时少于10次APC的患者中CIS或TIA的年复发率为2.9%，每小时10 - 30次APC的患者为11.0%，每小时多于30次APC的患者为22.6%（P = 0.001）。在多变量生存分析中，每小时多于30次APC与复发风险独立相关（风险比，3.40；95% CI，1.12 - 10.32；P = 0.030）。
在CIS或TIA患者中，频繁的房性异位活动（>30次APC/小时）与卒中或TIA复发风险增加独立相关。需要进一步研究验证频繁的房性异位活动作为隐源性卒中复发的危险因素，并确认其作为隐匿性房颤预测指标的作用。
