Department of Internal Medicine, Section on Hospital Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Int J Stroke. 2020 Aug;15(6):650-656. doi: 10.1177/1747493019876543. Epub 2019 Sep 17.
Prior studies examining the link between atrial cardiopathy and stroke risk have focused mainly on non-fatal stroke.
To examine the association between atrial cardiopathy and stroke mortality.
This analysis included 8028 participants (60.0 ± 13.4 years, 51.9% women, 49.8% white) from the Third National Health and Nutrition Examination (NHANES III) Survey. Atrial cardiopathy was defined as abnormal deep terminal negativity of the P wave in V1 (DTNPV1 = negative p-wave in V1<-100 µv), an electrocardiographic marker of atrial cardiopathy. Stroke mortality was ascertained using the National Death Index over a median follow-up of 14 years.
2.95% ( = 237) of the participants had atrial cardiopathy, and the prevalence was slightly higher in blacks (4%) versus whites (3%). During follow-up, stroke mortality was more common in those with (5.9%) than those without (2.7%) atrial cardiopathy; = .004. In a multivariable adjusted model, atrial cardiopathy was associated with a 76% increased risk of stroke mortality (HR (95% CI): 1.76 (1.02-3.04)]. This association was stronger in non-whites than whites (HR (95% CI): 3.50 (1.74-7.03) vs. 0.98 (0.40-2.42), respectively; interaction = 0.03). Among those with baseline atrial cardiopathy, the annualized stroke mortality rates/1000 participants across CHADS-VASc scores of 0, 1, and ≥2 were 0.0, 2.2, and 7.8, respectively.
Atrial cardiopathy is associated with an increased risk of stroke mortality, especially among non-whites. Among those with atrial cardiopathy, the risk of stroke mortality exponentially increases as the CHADS-VASc score becomes 2 or above. Randomized controlled trials are needed to assess the efficacy of anticoagulation in the prevention of ischemic stroke and thus, stroke mortality in the presence of atrial cardiopathy.
先前研究探讨心房心肌病与中风风险之间的关联主要集中在非致命性中风。
研究心房心肌病与中风死亡率之间的关联。
本分析纳入了第三次全国健康和营养调查（NHANES III）调查中的 8028 名参与者（60.0±13.4 岁，51.9%为女性，49.8%为白人）。心房心肌病定义为 V1 导联中异常深终末负向 P 波（DTNPV1=V1 中负向 p 波<-100μv），这是一种心房心肌病的心电图标志。中风死亡率通过国家死亡索引在中位数 14 年的随访中确定。
2.95%（=237）的参与者患有心房心肌病，黑人（4%）的患病率略高于白人（3%）。在随访期间，患有心房心肌病（5.9%）的参与者比无心房心肌病（2.7%）的参与者更常见中风死亡；=0.004。在多变量调整模型中，心房心肌病与中风死亡率增加 76%相关（HR（95%CI）：1.76（1.02-3.04]）。这种关联在非白人中比白人更强（HR（95%CI）：3.50（1.74-7.03）比 0.98（0.40-2.42），交互作用 = 0.03）。在基线时患有心房心肌病的患者中，CHADS-VASc 评分为 0、1 和≥2 的患者每年每 1000 名患者的年化中风死亡率分别为 0.0、2.2 和 7.8。
心房心肌病与中风死亡率增加相关，尤其是在非白人中。在患有心房心肌病的患者中，随着 CHADS-VASc 评分达到 2 或更高，中风死亡率呈指数增长。需要随机对照试验来评估抗凝在预防缺血性中风以及因此在存在心房心肌病的情况下预防中风死亡率方面的疗效。
