Zarkali Angeliki, Cheng Suk Fun, Dados Agnes, Simister Robert, Chandratheva Arvind
Hyperacute Stroke Unit, University College London Hospital, United Kingdom.
Division of Surgery and Interventional Science, University College London, United Kingdom.
J Stroke Cerebrovasc Dis. 2019 Jun;28(6):1495-1499. doi: 10.1016/j.jstrokecerebrovasdis.2019.03.017. Epub 2019 Mar 29.
Atrial fibrillation (AF) is a major cause of ischemic stroke and Transient Ischemic Attack (TIA) and investigation for paroxysmal AF is recommended following an embolic brain event. In contrast, retinal ischemic monocular blindness is traditionally considered most linked to carotid artery disease (CAS) and investigating for AF is less vigilant. We aimed to determine the prevalence of AF in patients with ischemic monocular blindness.
Consecutive records of all patients presenting to a daily TIA clinic with transient or permanent ischemic monocular blindness were reviewed, January 2014-October 2016.
Of 400 patients, 224 (56.0%) were male, mean age 64.5 years (SD 15.1). A total of 263 (66%) presented with transient and 137 (34%) with permanent ischemic monocular blindness. ECG was performed in 364 patients (91%) but only 211 (52%) had further cardiac monitoring. The vast majority (97.3%) had carotid imaging. Thirty-six patients (9%) were found to have AF while 53 (14%) had ipsilateral CAS. Median ABCD2 score was 1 in AF and non-AF groups. Only 55% of known AF patients were anticoagulated at presentation, despite all having CHADVASC2 score greater than or equal to 1. Patients with AF had more hypertension (P = .004), previous TIA (P = .002), previous stroke (P = .044) and ischemic heart disease (P = .022) with no difference in age (P = .791), diabetes (P = .563), smoking (P = .460) nor hypercholesterolaemia (P = .083).
A total of 9% of patients with ischemic monocular blindness had AF. This is an underestimate, as only 53% of patients had prolonged cardiac monitoring. Known AF was suboptimally managed with only 55% receiving anticoagulation despite being eligible.
心房颤动（AF）是缺血性卒中及短暂性脑缺血发作（TIA）的主要病因，栓塞性脑事件发生后建议对阵发性AF进行检查。相比之下，视网膜缺血性单眼盲传统上被认为与颈动脉疾病（CAS）关系最为密切，对AF的检查则不够警惕。我们旨在确定缺血性单眼盲患者中AF的患病率。
回顾了2014年1月至2016年10月期间每日TIA门诊所有出现短暂性或永久性缺血性单眼盲患者的连续记录。
400例患者中，224例（56.0%）为男性，平均年龄64.5岁（标准差15.1）。共有263例（66%）表现为短暂性缺血性单眼盲，137例（34%）表现为永久性缺血性单眼盲。364例患者（91%）进行了心电图检查，但只有211例（52%）进行了进一步的心脏监测。绝大多数（97.3%）患者进行了颈动脉成像检查。36例患者（9%）被发现患有AF，53例（14%）患有同侧CAS。AF组和非AF组的ABCD2评分中位数均为1。尽管所有已知AF患者的CHADVASC2评分均大于或等于1，但就诊时只有55%的患者接受了抗凝治疗。AF患者患高血压（P = 0.004）、既往TIA（P = 0.002）、既往卒中（P = 0.044）和缺血性心脏病（P = 0.022）的比例更高，而在年龄（P = 0.791）、糖尿病（P = 0.563）、吸烟（P = 0.460）和高胆固醇血症（P = 0.083）方面无差异。
缺血性单眼盲患者中共有9%患有AF。这是一个低估数字，因为只有53%的患者进行了长时间的心脏监测。已知AF患者的治疗效果不佳，尽管符合条件，但只有55%的患者接受了抗凝治疗。
