Müller Patrick, Ivanov Vladimir, Kara Kaffer, Klein-Wiele Oliver, Forkmann Mathias, Piorkowski Christopher, Blockhaus Christian, Dimitroulis Dimitrios, Afzal Shazia, Shin Dong-In, Kelm Malte, Makimoto Hisaki, Mügge Andreas
Division of Cardiology, Pulmonology, and Vascular Medicine, Cardiac Arrhythmia Service, University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, 40225, Düsseldorf, Germany.
Cardiovascular Center, St. Josef Hospital Bochum, Ruhr-University Bochum, Bochum, Germany.
Clin Res Cardiol. 2017 Feb;106(2):113-119. doi: 10.1007/s00392-016-1029-2. Epub 2016 Aug 19.
Insertable cardiac monitor (ICM) increases the detection rate of occult atrial fibrillation (AF) after cryptogenic stroke. The aim of this study was to evaluate the prognostic significance of total atrial conduction time (TACT) assessed by tissue Doppler imaging (PA-TDI interval) to predict AF presence in patients with cryptogenic stroke.
Ninety patients (57.7 ± 12.3 years, 48 % women) after acute cryptogenic stroke and ICM implantation were prospective recruited at four centers for continuous rhythm monitoring. In all patients, TACT was measured by PA-TDI interval via echocardiography. Patients were followed up (331 ± 186 days) for detection of AF (defined by episode lasting ≥30 s).
AF was detected in 16 patients (18 %) during follow-up (331 ± 186 days). The median period to AF detection was 30 days (q1-q3; 16-62 days). Patients who exhibited occult AF were characterized by significantly longer PA-TDI intervals (154.7 ± 12.6 vs. 133.9 ± 9.5 ms, p < 0.0001). The cut-off value of PA-TDI interval at 145 ms demonstrated sensitivity and specificity for AF detection of 93.8 and 90.5 %, respectively. In multivariate analysis, CHA2DS2-VASc score (HR 1.96 per 1 point, p < 0.01) and longer PA-TDI interval (HR 4.05 per 10 ms, p < 0.0001) were independent predictors of occult AF.
Our data suggest that measurement of TACT could help to predict future AF detection in patients with cryptogenic stroke. The clinical importance of prolonged rhythm monitoring or indication of direct anticoagulation therapy after cryptogenic stroke based on TACT should be further investigated.
植入式心脏监测器（ICM）可提高隐源性卒中后隐匿性心房颤动（AF）的检出率。本研究旨在评估通过组织多普勒成像评估的全心房传导时间（TACT）（PA-TDI间期）对预测隐源性卒中患者是否存在AF的预后意义。
在四个中心前瞻性招募了90例急性隐源性卒中后植入ICM的患者（年龄57.7±12.3岁，48%为女性），进行连续心律监测。对所有患者通过超声心动图用PA-TDI间期测量TACT。对患者进行随访（331±186天）以检测AF（定义为发作持续≥30秒）。
随访期间（331±186天）16例患者（18%）检测到AF。检测到AF的中位时间为30天（四分位间距；16-62天）。出现隐匿性AF的患者其PA-TDI间期显著更长（154.7±12.6 vs. 133.9±9.5毫秒，p<0.0001）。PA-TDI间期为145毫秒时的截断值对AF检测的敏感性和特异性分别为93.8%和90.5%。多因素分析中，CHA2DS2-VASc评分（每增加1分HR为1.96，p<0.01）和更长的PA-TDI间期（每增加10毫秒HR为4.05，p<0.0001）是隐匿性AF的独立预测因素。
我们的数据表明，测量TACT有助于预测隐源性卒中患者未来是否会检测到AF。基于TACT的隐源性卒中后延长心律监测的临床重要性或直接抗凝治疗的指征应进一步研究。
