Pagola Jorge, Juega Jesus, Francisco-Pascual Jaume, Bustamante Alejandro, Penalba Anna, Pala Elena, Rodriguez Maite, De Lera-Alfonso Mercedes, Arenillas Juan F, Cabezas Juan Antonio, Moniche Francisco, de Torres Reyes, Montaner Joan, González-Alujas Teresa, Alvarez-Sabin Jose, Molina Carlos A
Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain.
Arrhythmia Unit-Cardiology Department, CIBER-CV, Valld'Hebrón Hospital, Barcelona, Spain.
Transl Stroke Res. 2021 Oct;12(5):735-741. doi: 10.1007/s12975-020-00873-2. Epub 2020 Nov 13.
The aim of the study was to determine markers of atrial dysfunction in patients with cryptogenic stroke to predict episodes of paroxysmal atrial fibrillation with high risk of embolization (HpAF). We classified patients included in the Crypto-AF study, Cryptogenic Stroke registry, to detect paroxysmal atrial fibrillation (pAF) with wearable Holter, according to the longest episode of pAF in three groups: without pAF detection, episodes of pAF shorter than 5 h, and episodes of pAF longer than 5 h (HpAF). Atrial dysfunction surrogates were evaluated: EKG pattern, Holter record and echocardiography parameters (left atria volume (LAVI), and peak atrial longitudinal and contraction strain (PALS and PACS). The level of N-terminal pro b-type natriuretic peptide (NT-proBNP) was determined. All patients were followed for 2 years to detect pAF and stroke recurrence. From 308 patients, 253 patients with high quality Holter analysis were selected. The distribution was No pAF 78.6% (n = 199), pAF < 5 h 7.9% (n = 20), and HpAF > 5 h 13.4% (n = 34). Age of the patients and combination of PALS and NT-proBNP independently predicted HpAF OR 1.07 (1.00; 1.15) and OR 3.05 (1.08; 8.60) respectively. The validity of PALS and NT-proBNP to detect patients at risk of HpAF was higher than the validity of age (AUC 0.82, sensitivity 78.95%, specificity 63%). Patients with PALS < 25% and NT-proBNP > 283 pg/ml had more detection of pAF during follow-up 35% vs. 5.1% OR 2.33 (1.05-5.13) (p < 0.001). Multimodal assessment of atrial dysfunction with PALS and NT-proBNP improved the prediction of pAF episodes with high embolic risk in patients with cryptogenic stroke.
本研究的目的是确定隐源性卒中患者心房功能障碍的标志物，以预测具有高栓塞风险的阵发性心房颤动（HpAF）发作。我们对纳入Crypto-AF研究（隐源性卒中登记）的患者进行分类，使用可穿戴式动态心电图监测仪检测阵发性心房颤动（pAF），根据pAF最长发作时间分为三组：未检测到pAF、pAF发作时间短于5小时、pAF发作时间长于5小时（HpAF）。评估心房功能障碍替代指标：心电图模式、动态心电图记录和超声心动图参数（左心房容积（LAVI）以及心房纵向峰值应变和收缩期应变（PALS和PACS））。测定N末端B型脑钠肽前体（NT-proBNP）水平。所有患者随访2年以检测pAF和卒中复发。从308例患者中，选择了253例进行高质量动态心电图分析的患者。分布情况为：无pAF占78.6%（n = 199），pAF<5小时占7.9%（n = 20），HpAF>5小时占13.4%（n = 34）。患者年龄以及PALS与NT-proBNP的组合分别独立预测HpAF，OR为1.07（1.00；1.15）和OR为3.05（1.08；8.60）。PALS和NT-proBNP检测HpAF风险患者的有效性高于年龄的有效性（AUC为0.82，敏感性为78.95%，特异性为63%）。PALS<25%且NT-proBNP>283 pg/ml的患者在随访期间pAF检测率更高，分别为35%和5.1%，OR为2.33（1.05 - 5.13）（p<0.001）。使用PALS和NT-proBNP对心房功能障碍进行多模式评估，可改善对隐源性卒中患者具有高栓塞风险的pAF发作的预测。
