Pimentel Bernardo Crespo, Ingwersen Thies, Haeusler Karl Georg, Schlemm Eckhard, Forkert Nils D, Rajashekar Deepthi, Mouches Pauline, Königsberg Alina, Kirchhof Paulus, Kunze Claudia, Tütüncü Serdar, Olma Manuel C, Krämer Michael, Michalski Dominik, Kraft Andrea, Rizos Timolaos, Helberg Torsten, Ehrlich Sven, Nabavi Darius G, Röther Joachim, Laufs Ulrich, Veltkamp Roland, Heuschmann Peter U, Cheng Bastian, Endres Matthias, Thomalla Götz
Department of Neurology, Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.
Eur Stroke J. 2022 Sep;7(3):230-237. doi: 10.1177/23969873221100895. Epub 2022 May 25.
Paroxysmal Atrial fibrillation (AF) is often clinically silent and may be missed by the usual diagnostic workup after ischemic stroke. We aimed to determine whether shape characteristics of ischemic stroke lesions can be used to predict AF in stroke patients without known AF at baseline. Lesion shape quantification on brain MRI was performed in selected patients from the intervention arm of the (MonDAFIS) study, which included patients with ischemic stroke or TIA without prior AF. Multiple morphologic parameters were calculated based on lesion segmentation in acute brain MRI data. Multivariate logistic models were used to test the association of lesion morphology, clinical parameters, and AF. A stepwise elimination regression was conducted to identify the most important variables. A total of 755 patients were included. Patients with AF detected within 2 years after stroke ( = 86) had a larger overall oriented bounding box (OBB) volume ( = 0.003) and a higher number of brain lesion components ( = 0.008) than patients without AF. In the multivariate model, OBB volume (OR 1.72, 95%CI 1.29-2.35, < 0.001), age (OR 2.13, 95%CI 1.52-3.06, < 0.001), and female sex (OR 2.45, 95%CI 1.41-4.31, = 0.002) were independently associated with detected AF. Ischemic lesions in patients with detected AF after stroke presented with a more dispersed infarct pattern and a higher number of lesion components. Together with clinical characteristics, these lesion shape characteristics may help in guiding prolonged cardiac monitoring after stroke.
阵发性心房颤动（AF）在临床上通常没有症状，在缺血性中风后常规的诊断检查中可能会被漏诊。我们旨在确定缺血性中风病灶的形状特征是否可用于预测基线时无已知AF的中风患者发生AF的情况。对（MonDAFIS）研究干预组中选定的患者进行了脑部MRI的病灶形状量化，该研究纳入了既往无AF的缺血性中风或短暂性脑缺血发作（TIA）患者。基于急性脑MRI数据中的病灶分割计算了多个形态学参数。使用多变量逻辑模型来检验病灶形态、临床参数与AF之间的关联。进行逐步消除回归以确定最重要的变量。共纳入755例患者。中风后2年内检测到AF的患者（n = 86）与未检测到AF的患者相比，总体定向边界框（OBB）体积更大（P = 0.003），脑病灶成分数量更多（P = 0.008）。在多变量模型中，OBB体积（比值比[OR] 1.72，95%置信区间[CI] 1.29 - 2.35，P < 0.001）、年龄（OR 2.13，95%CI 1.52 - 3.06，P < 0.001）和女性性别（OR 2.45，95%CI 1.41 - 4.31，P = 0.002）与检测到的AF独立相关。中风后检测到AF的患者的缺血性病灶呈现出更分散的梗死模式和更多的病灶成分。连同临床特征，这些病灶形状特征可能有助于指导中风后的长期心脏监测。
