Vetta Giampaolo, Parlavecchio Antonio, Caminiti Rodolfo, Crea Pasquale, Magnocavallo Michele, Della Rocca Domenico Giovanni, Lavalle Carlo, Vetta Francesco, Marano Giovanni, Ruggieri Chiara, Lofrumento Francesca, Dattilo Giuseppe, Ferraù Ludovica, Dell'Aera Cristina, Giammello Fabrizio, La Spina Paolino, Musolino Rosa Fortunata, Luzza Francesco, Carerj Scipione, Micari Antonio, Di Bella Gianluca
Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
J Electrocardiol. 2022 Sep-Oct;74:46-53. doi: 10.1016/j.jelectrocard.2022.07.071. Epub 2022 Jul 29.
Atrial fibrillation (AF) is the main cardiac cause of stroke, but it frequently remains undetected. In patients with cryptogenic stroke an Holter electrocardiogram (ECG) monitoring for AF is recommended.
To evaluate the prognostic role of Non-Conducted Premature Atrial Complexes (ncPACs) recorded on Holter ECG.
We prospectively enrolled consecutive patients admitted to the Stroke Unit of our hospital with a diagnosis of cryptogenic stroke between December 2018 and January 2020; all patients underwent 24-h Holter ECG monitoring during hospitalization. Two follow-up visits were scheduled, including a 24-h Holter ECG at 3 and 6 months to detect AF.
Among 112 patients, 58% were male with an average age of 72.2 ± 12.2 years. At follow-up, AF was diagnosed in 21.4% of the population. The baseline 24-h Holter ECG burden of ncPACs and Premature Atrial Complexes (PACs) was higher in patients with AF detected on follow-up (13.5 vs 2, p = 0.001; 221.5 vs 52; p = 0.01). ROC analysis showed that ncPACs had the best diagnostic accuracy in predicting AF (AUC:0.80; 95% CI 0.68-0.92). Cut-off value of ≥7 for ncPACs burden showed the highest accuracy with sensitivity of 62.5% and specificity 97.7% to predict AF onset at follow-up. Moreover, at multivariate Cox-proportional hazard analysis ncPACs burden ≥7 was a powerful independent predictor of AF onset (HR 12.4; 95% CI 4.8-32.8; p < 0.0001).
NcPACs burden ≥7 represents a new predictor of AF that could guide the screening of this arrhythmia in cryptogenic stroke patients.
心房颤动（AF）是中风的主要心脏病因，但常常未被发现。对于不明原因的中风患者，建议进行动态心电图（ECG）监测以检测房颤。
评估动态心电图记录的未下传房性早搏（ncPACs）的预后作用。
我们前瞻性纳入了2018年12月至2020年1月期间我院卒中单元收治的连续诊断为不明原因中风的患者；所有患者在住院期间均接受了24小时动态心电图监测。安排了两次随访，包括在3个月和6个月时进行24小时动态心电图检查以检测房颤。
112例患者中，58%为男性，平均年龄72.2±12.2岁。随访时，21.4%的患者被诊断为房颤。随访时检测到房颤的患者，其基线24小时动态心电图中ncPACs和房性早搏（PACs）的负荷更高（13.5对2，p = 0.001；221.5对52；p = 0.01）。ROC分析显示，ncPACs在预测房颤方面具有最佳诊断准确性（AUC：0.80；95%CI 0.68 - 0.92）。ncPACs负荷≥7的截断值显示出最高准确性，预测随访时房颤发作的敏感性为62.5%，特异性为97.7%。此外，在多变量Cox比例风险分析中，ncPACs负荷≥7是房颤发作的有力独立预测因素（HR 12.4；95%CI 4.8 - 32.8；p < 0.）。
ncPACs负荷≥7代表房颤的一个新预测因素，可指导不明原因中风患者对这种心律失常的筛查。
