From the Institute of Cardiovascular and Medical Sciences (A.C., H.K.C., R.-P.L., D.D., M.H., P.K., T.Q., J.D.) and Institute of Neuroscience and Psychology (A.A.-R.), University of Glasgow, UK; Faculty of Medicine (H.K.C.), University of Hong Kong, Pokfulam; and Liverpool Centre for Cardiovascular Science (G.L.), University of Liverpool, UK.
Neurology. 2021 Nov 2;97(18):e1775-e1789. doi: 10.1212/WNL.0000000000012769. Epub 2021 Sep 9.
To identify clinical, ECG, and blood-based biomarkers associated with atrial fibrillation (AF) detection after ischaemic stroke or TIA that could help inform patient selection for cardiac monitoring.
We performed a systematic review and meta-analysis and searched electronic databases for cohort studies from January 15, 2000, to January 15, 2020. The outcome was AF ≥30 seconds within 1 year after ischemic stroke/TIA. We used random effects models to create summary estimates of risk. Risk of bias was assessed using the Quality in Prognostic Studies tool.
We identified 8,503 studies, selected 34 studies, and assessed 69 variables (42 clinical, 20 ECG, and 7 blood-based biomarkers). The studies included 11,569 participants and AF was detected in 1,478 (12.8%). Overall, risk of bias was moderate. Variables associated with increased likelihood of AF detection are older age (odds ratio [OR] 3.26, 95% confidence interval [CI] 2.35-4.54), female sex (OR 1.47, 95% CI 1.23-1.77), a history of heart failure (OR 2.56, 95% CI 1.87-3.49), hypertension (OR 1.42, 95% CI 1.15-1.75) or ischemic heart disease (OR 1.80, 95% CI 1.34-2.42), higher modified Rankin Scale (OR 6.13, 95% CI 2.93-12.84) or National Institutes of Health Stroke Scale score (OR 2.50, 95% CI 1.64-3.81), no significant carotid/intracranial artery stenosis (OR 3.23, 95% CI 1.14-9.11), no tobacco use (OR 1.93, 95% CI 1.48-2.51), statin therapy (OR 2.07, 95% CI 1.14-3.73), stroke as index diagnosis (OR 1.59, 95% CI 1.17-2.18), systolic blood pressure (OR 1.61, 95% CI 1.16-2.22), IV thrombolysis treatment (OR 2.40, 95% CI 1.83-3.16), atrioventricular block (OR 2.12, 95% CI 1.08-4.17), left ventricular hypertrophy (OR 2.21, 95% CI 1.03-4.74), premature atrial contraction (OR 3.90, 95% CI 1.74-8.74), maximum P-wave duration (OR 3.19, 95% CI 1.40-7.25), PR interval (OR 2.32, 95% CI 1.11-4.83), P-wave dispersion (OR 7.79, 95% CI 4.16-14.61), P-wave index (OR 3.44, 95% CI 1.87-6.32), QTc interval (OR 3.68, 95% CI 1.63-8.28), brain natriuretic peptide (OR 13.73, 95% CI 3.31-57.07), and high-density lipoprotein cholesterol (OR 1.49, 95% CI 1.17-1.88) concentrations. Variables associated with reduced likelihood are minimum P-wave duration (OR 0.53, 95% CI 0.29-0.98), low-density lipoprotein cholesterol (OR 0.73, 95% CI 0.57-0.93), and triglyceride (OR 0.51, 95% CI 0.41-0.64) concentrations.
We identified multimodal biomarkers that could help guide patient selection for cardiac monitoring after ischaemic stroke/TIA. Their prognostic utility should be prospectively assessed with AF detection and recurrent stroke as outcomes.
确定与缺血性卒中和 TIA 后心房颤动（AF）检测相关的临床、心电图和基于血液的生物标志物，这些标志物可能有助于为心脏监测选择患者提供信息。
我们进行了系统评价和荟萃分析，并从 2000 年 1 月 15 日至 2020 年 1 月 15 日，对电子数据库进行了队列研究的检索。主要结局是缺血性卒中和 TIA 后 1 年内 AF 持续时间≥30 秒。我们使用随机效应模型来创建风险的综合估计。使用预后研究质量工具评估偏倚风险。
我们确定了 8503 项研究，选择了 34 项研究，并评估了 69 个变量（42 个临床、20 个心电图和 7 个基于血液的生物标志物）。这些研究包括 11569 名参与者，1478 名（12.8%）检测到 AF。总体而言，偏倚风险为中度。与 AF 检测可能性增加相关的变量是年龄较大（优势比 [OR] 3.26，95%置信区间 [CI] 2.35-4.54）、女性（OR 1.47，95% CI 1.23-1.77）、心力衰竭史（OR 2.56，95% CI 1.87-3.49）、高血压（OR 1.42，95% CI 1.15-1.75）或缺血性心脏病（OR 1.80，95% CI 1.34-2.42）、改良 Rankin 量表评分较高（OR 6.13，95% CI 2.93-12.84）或 NIH 卒中量表评分较高（OR 2.50，95% CI 1.64-3.81）、无显著颈动脉/颅内动脉狭窄（OR 3.23，95% CI 1.14-9.11）、无烟草使用（OR 1.93，95% CI 1.48-2.51）、他汀类药物治疗（OR 2.07，95% CI 1.14-3.73）、以卒中作为首发诊断（OR 1.59，95% CI 1.17-2.18）、收缩压（OR 1.61，95% CI 1.16-2.22）、静脉溶栓治疗（OR 2.40，95% CI 1.83-3.16）、房室传导阻滞（OR 2.12，95% CI 1.08-4.17）、左心室肥厚（OR 2.21，95% CI 1.03-4.74）、房性早搏（OR 3.90，95% CI 1.74-8.74）、最大 P 波持续时间（OR 3.19，95% CI 1.40-7.25）、PR 间期（OR 2.32，95% CI 1.11-4.83）、P 波离散度（OR 7.79，95% CI 4.16-14.61）、P 波指数（OR 3.44，95% CI 1.87-6.32）、QTc 间期（OR 3.68，95% CI 1.63-8.28）、脑利钠肽（OR 13.73，95% CI 3.31-57.07）和高密度脂蛋白胆固醇（OR 1.49，95% CI 1.17-1.88）浓度。与 AF 检测可能性降低相关的变量是最小 P 波持续时间（OR 0.53，95% CI 0.29-0.98）、低密度脂蛋白胆固醇（OR 0.73，95% CI 0.57-0.93）和甘油三酯（OR 0.51，95% CI 0.41-0.64）浓度。
我们确定了多种生物标志物，这些标志物可能有助于为缺血性卒中和 TIA 后心脏监测选择患者提供信息。它们的预后预测价值应作为 AF 检测和复发性卒中的结局进行前瞻性评估。
