Scheitz Jan F, Erdur Hebun, Haeusler Karl Georg, Audebert Heinrich J, Roser Mattias, Laufs Ulrich, Endres Matthias, Nolte Christian H
From the Center for Stroke Research Berlin (J.F.S., K.G.H., H.J.A., M.E., C.H.N.), Klinik für Neurologie (J.F.S., H.E., K.G.H., H.J.A., M.E., C.H.N.), and Excellence Cluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik für Kardiologie und Pulmonologie, Charité, Berlin, Germany (M.R.); and Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany (U.L.).
Stroke. 2015 May;46(5):1196-201. doi: 10.1161/STROKEAHA.115.008681. Epub 2015 Apr 2.
Detection rates of paroxysmal atrial fibrillation (AF) after acute ischemic stroke increase with duration of ECG monitoring. To date, it is unknown which patient group may benefit most from intensive monitoring strategies. Therefore, we aimed to identify predictors of previously unknown AF during in-hospital ECG monitoring.
All consecutive patients with imaging-confirmed ischemic stroke admitted to our tertiary care hospital from February 2011 to December 2013 were registered prospectively. Patients received continuous bedside ECG monitoring for at least 24 hours. Detection of previously unknown AF during in-hospital ECG monitoring was obtained from medical records. Patients with AF on admission ECG or known history of AF were excluded from analysis.
Among 1228 patients (median age, 73 years; median National Institutes of Health Stroke Scale, 4; 43.4% women), previously unknown AF was detected in 114 (9.3%) during a median time of continuous ECG monitoring of 3 days (interquartile range, 2-4 days). Duration of monitoring (P<0.01), older age (P<0.01), history of hypertension (P=0.03), insular cortex involvement (P<0.01), and higher high-sensitivity cardiac troponin T (P=0.04) on admission were independently associated with subsequent detection of AF in a multiple regression analysis. Addition of high-sensitivity cardiac troponin T, insular cortex stroke, or both to the CHADS2 score (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke [2P]) significantly improved c-statistics from 0.63 to 0.68 (P=0.01), 0.70 (P<0.01), and 0.72 (P<0.001), respectively.
Insular cortex involvement, higher admission high-sensitivity cardiac troponin T, older age, hypertension, and longer monitoring are associated with new detection of AF during in-hospital ECG monitoring. Patients with higher high-sensitivity cardiac troponin T or insular cortex involvement may be candidates for prolonged ECG monitoring.
急性缺血性卒中后阵发性心房颤动（AF）的检出率随心电图监测时长增加而升高。迄今为止，尚不清楚哪类患者群体可能从强化监测策略中获益最大。因此，我们旨在确定住院期间心电图监测时既往未知AF的预测因素。
前瞻性登记2011年2月至2013年12月入住我们三级医疗中心且影像学确诊为缺血性卒中的所有连续患者。患者接受至少24小时的床边连续心电图监测。住院期间心电图监测时既往未知AF的检测结果来自病历。入院心电图有AF或已知AF病史的患者被排除在分析之外。
在1228例患者（中位年龄73岁；中位美国国立卫生研究院卒中量表评分4分；43.4%为女性）中，连续心电图监测中位时间为3天（四分位间距2 - 4天）时，114例（9.3%）检测到既往未知AF。多因素回归分析显示，监测时长（P<0.01）、年龄较大（P<0.01）、高血压病史（P=0.03）、岛叶皮质受累（P<0.01）以及入院时较高的高敏心肌肌钙蛋白T水平（P=0.04）与随后AF的检测独立相关。将高敏心肌肌钙蛋白T、岛叶皮质卒中或两者加入CHADS2评分（充血性心力衰竭、高血压、年龄≥75岁、糖尿病、卒中[2分]）后，c统计量分别从0.63显著提高至0.68（P=0.01）、0.70（P<0.01）和0.72（P<0.001）。
岛叶皮质受累、入院时较高的高敏心肌肌钙蛋白T水平、年龄较大、高血压以及较长的监测时间与住院期间心电图监测时新检测到AF相关。高敏心肌肌钙蛋白T水平较高或岛叶皮质受累的患者可能适合延长心电图监测。
