不明原因卒中后患者心房颤动检出的预测因素及复发性卒中的特征。
Predictors of atrial fibrillation detection and features of recurrent strokes in patients after cryptogenic stroke.
机构信息
Cone Health Stroke Center, Greensboro, NC, United States; Guilford Neurologic Research, Greensboro, NC, United States.
Cone Health Stroke Center, Greensboro, NC, United States; Guilford Neurologic Research, Greensboro, NC, United States; Guilford Neurologic Associates, Greensboro, NC, United States.
出版信息
J Stroke Cerebrovasc Dis. 2020 Sep;29(9):104934. doi: 10.1016/j.jstrokecerebrovasdis.2020.104934. Epub 2020 Jun 25.
BACKGROUND AND PURPOSE
Use of implantable cardiac monitors (ICMs) has increased diagnosis of atrial fibrillation (AF) in cryptogenic stroke (CS) patients. Identifying AF predictors may enhance the yield of AF detection. Recurrent strokes after CS are not well described. We aimed to assess the predictors for AF detection and the characteristics of recurrent strokes in patients after CS.
METHODS
We reviewed electronic medical records of CS patients who were admitted between February 2014 and September 2017 and underwent ICM placement with minimum one-year follow-up. Patient demographics, stroke characteristics, pre-defined risk factors as well as recurrent strokes were compared between patients with and without AF detection.
RESULTS
389 patients with median follow-up of 548 days were studied. AF was detected in 102 patients (26.2%). Age (per decade increase, OR 2.10, CI 1.64-2.68, with vs. without AF) and left atrium diameter (per 5 mm increase, OR 1.91, CI 1.33-2.74) were identified as AF predictors. Intracranial large vessel stenosis >50% irrelevant to the index strokes was associated with AF detection within 30 days (OR 0.24, CI 0.09-0.69, >30 vs. <30 days). Recurrent strokes occurred in 14% patients with median follow-up about 2.5 years. Topography of these strokes resembled embolic pattern and was comparable between patients with and without AF. Among recurrent strokes in patients with AF, the median time to AF detection was much shorter (90 vs. 251 days), and the median time to first stroke recurrence was much longer (422 vs. 76 days) in patients whose strokes recurred after AF detection than those before AF detection.
CONCLUSIONS
Older age and enlarged left atrium are predictors for AF detection in CS patients. Intracranial atherosclerosis is more prevalent in patients with early AF detection within 30 days. Recurrent strokes follow the embolic pattern, and early AF detection could delay the stroke recurrence.
背景与目的
植入式心脏监测器（ICM）的使用增加了隐源性卒中（CS）患者中房颤（AF）的诊断。确定 AF 的预测因素可能会提高 AF 检测的效果。CS 后复发性卒中的情况描述并不完善。我们旨在评估 CS 患者中 AF 检测的预测因素以及 CS 后复发性卒中的特征。
方法
我们回顾了 2014 年 2 月至 2017 年 9 月期间接受 ICM 植入并随访至少一年的 CS 患者的电子病历。比较了有和无 AF 检测的患者之间的患者人口统计学、卒中特征、预定义的危险因素以及复发性卒中。
结果
研究了 389 例中位随访时间为 548 天的患者。102 例（26.2%）患者检测到 AF。年龄（每增加十年，OR 2.10，95%CI 1.64-2.68，与有 vs. 无 AF 相比）和左心房直径（每增加 5 毫米，OR 1.91，95%CI 1.33-2.74）被确定为 AF 的预测因素。颅内大血管狭窄>50%与指数卒中无关，但与 30 天内 AF 检测相关（OR 0.24，95%CI 0.09-0.69，>30 与 <30 天）。14%的患者在中位随访约 2.5 年后发生了复发性卒中。这些卒中的发病部位类似于栓塞模式，且在有和无 AF 的患者之间相似。在有 AF 的患者中，复发性卒中的中位时间更短（90 与 251 天），且 AF 检测后首次卒中复发的中位时间更长（422 与 76 天）。
结论
年龄较大和左心房增大是 CS 患者中 AF 检测的预测因素。颅内动脉粥样硬化在 30 天内早期 AF 检测的患者中更为常见。复发性卒中呈栓塞模式，早期 AF 检测可延迟卒中复发。
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