O'Neal Wesley T, Kamel Hooman, Zhang Zhu-Ming, Chen Lin Y, Alonso Alvaro, Soliman Elsayed Z
From the Department of Medicine (W.T.O.) and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention (Z.-M.Z., E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (H.K.), Weill Cornell Medical College, New York, NY; and Department of Medicine, Cardiovascular Division (L.Y.C.), and Division of Epidemiology and Community Health, School of Public Health (A.A.), University of Minnesota, Minneapolis, MN. W.T.O. is currently with the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA; and A.A. is currently with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
Neurology. 2016 Jul 26;87(4):352-6. doi: 10.1212/WNL.0000000000002888. Epub 2016 Jun 24.
Given that recent reports have suggested left atrial disease to be an independent risk factor for ischemic stroke, we sought to examine if advanced interatrial block (aIAB) is an independent stroke risk factor.
We examined the association between aIAB and incident ischemic stroke in 14,716 participants (mean age 54 ± 5.8 years; 55% female; 26% black) from the Atherosclerosis Risk in Communities Study (ARIC). Cases of aIAB were identified from digital ECGs recorded during the baseline ARIC visit (1987-1989) and the first 3 follow-up study visits (1990-1992, 1993-1995, and 1996-1998). Adjudicated ischemic stroke events were ascertained through December 31, 2010.
There were 266 (1.8%) participants who had evidence of aIAB. Over a median follow-up of 22 years, 916 (6.2%) ischemic stroke events were detected. The incidence rate (per 1,000 person-years) of ischemic stroke among those with aIAB (incidence rate 8.05, 95% confidence interval [CI] 5.7, 11.4) was more than twice the rate in those without aIAB (incidence rate 3.14, 95% CI 2.94, 3.35). In a multivariable Cox regression analysis adjusted for stroke risk factors and potential confounders, aIAB was associated with an increased risk of ischemic stroke (hazard ratio 1.63, 95% CI 1.13, 2.34). The results were consistent across subgroups of participants stratified by age, sex, and race.
In the ARIC, aIAB was associated with incident ischemic stroke, which strengthens the hypothesis that left atrial disease should be considered an independent stroke risk factor.
鉴于近期报告提示左心房疾病是缺血性卒中的独立危险因素，我们试图研究晚期房间阻滞（aIAB）是否为独立的卒中危险因素。
我们在社区动脉粥样硬化风险研究（ARIC）的14716名参与者（平均年龄54±5.8岁；55%为女性；26%为黑人）中研究aIAB与缺血性卒中发病之间的关联。aIAB病例通过ARIC基线访视（1987 - 1989年）及前3次随访研究访视（1990 - 1992年、1993 - 1995年和1996 - 1998年）期间记录的数字心电图确定。经判定的缺血性卒中事件确定至2010年12月31日。
有266名（1.8%）参与者有aIAB证据。在中位随访22年期间，检测到916例（6.2%）缺血性卒中事件。有aIAB者的缺血性卒中发病率（每1000人 - 年）（发病率8.05，95%置信区间[CI]5.7，11.4）是无aIAB者发病率（发病率3.14，95%CI2.94，3.35）的两倍多。在针对卒中危险因素和潜在混杂因素进行调整的多变量Cox回归分析中，aIAB与缺血性卒中风险增加相关（风险比1.63，95%CI1.13，2.34）。按年龄、性别和种族分层的参与者亚组结果一致。
在ARIC研究中，aIAB与缺血性卒中发病相关，这强化了左心房疾病应被视为独立卒中危险因素的假说。
