Iwakawa Hidehiro, Terata Ken, Kato Ryosuke, Kaimori Ryota, Tashiro Haruwo, Sato Wakana, Watanabe Hiroyuki
Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan.
Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan.
Int J Cardiol. 2022 Dec 1;368:72-77. doi: 10.1016/j.ijcard.2022.08.037. Epub 2022 Aug 23.
Our aim was to analyze the incidence of P-wave abnormalities in embolic and non-embolic strokes, and evaluate its clinical usefulness for predicting stroke etiology.
We included 376 consecutive patients hospitalized for acute ischemic stroke from January 2015 to September 2021. Among the patients in sinus rhythm at admission, 31 had ischemic stroke due to atrial fibrillation (AF)-related embolism, 59 had embolic stroke of unknown source (ESUS), and 143 had non-embolic stroke. P-wave abnormalities were defined as 1. P-wave axis abnormality (PWAA); 2. P-wave terminal force in V (PTFV1) ≤ -4000 μV*ms; 3. advanced inter-atrial block (A-IAB).
The prevalence of each type of abnormality was consistently lower in patients with non-embolic stroke than in those with AF-related embolism (AF-related vs. ESUS vs. non-embolic; PWAA, 45% vs. 20% vs. 14%; PTFV1, 36% vs. 37% vs. 15%; and A-IAB, 55% vs. 31% vs. 13%, respectively). The identification of at least one type of P-wave abnormality improved the sensitivity compared to using a single abnormality parameter (sensitivity 72%, specificity 62%), while at least two types of abnormality had low sensitivity, but high specificity (sensitivity 29%, specificity 95%). Multivariate regression analysis revealed that identification of at least one type of P-wave abnormality was independently associated with embolic stroke (odds ratio 3.11, 95%CI 1.46-6.63).
The incidence of each type of P-wave abnormality was significantly lower in patients with non-embolic stroke. A combination of PWAA, PTFV1, and A-IAB parameters could be useful for distinguishing embolic from non-embolic stroke.
我们的目的是分析栓塞性和非栓塞性卒中患者P波异常的发生率，并评估其对预测卒中病因的临床实用性。
我们纳入了2015年1月至2021年9月期间因急性缺血性卒中住院的376例连续患者。在入院时窦性心律的患者中，31例因心房颤动（AF）相关栓塞导致缺血性卒中，59例为不明来源栓塞性卒中（ESUS），143例为非栓塞性卒中。P波异常定义为：1. P波电轴异常（PWAA）；2. V导联P波终末电势（PTFV1）≤-4000 μV*ms；3. 进展性房内阻滞（A-IAB）。
非栓塞性卒中患者中每种异常类型的患病率始终低于AF相关栓塞患者（AF相关 vs. ESUS vs. 非栓塞性；PWAA，45% vs. 20% vs. 14%；PTFV1，36% vs. 37% vs. 15%；A-IAB，分别为55% vs. 31% vs. 13%）。与使用单一异常参数相比，识别至少一种类型的P波异常可提高敏感性（敏感性72%，特异性62%），而至少两种类型的异常敏感性较低，但特异性较高（敏感性29%，特异性95%）。多因素回归分析显示，识别至少一种类型的P波异常与栓塞性卒中独立相关（比值比3.11，95%CI 1.46-6.63）。
非栓塞性卒中患者中每种类型P波异常的发生率显著较低。PWAA、PTFV1和A-IAB参数的组合可能有助于区分栓塞性卒中和非栓塞性卒中。
