Alaarag Ahmed, Abdelkhalek Hazem, Amin Osama
Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Neurology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Egypt Heart J. 2022 Sep 24;74(1):68. doi: 10.1186/s43044-022-00305-6.
Increased nighttime BP variability (BPV) was associated with stroke. Left atrial (LA) enlargement is the default clinical hallmark of structural remodeling that often occurs in response to LA pressure and volume overload. Blood pressure has proven to be an essential determinant of LA enlargement. We aimed to evaluate the influence of BPV as a risk factor for cryptogenic stroke and highlight the importance of including the (APBM) in the workup for those patients and test the relation between BPV and LA remodeling in these patients, which could be used as a clue to add APM monitoring to their workup. Also, LA remodeling may be a substrate for occult atrial fibrillation (AF). We included Group I (108 consecutive patients with cryptogenic ischemic stroke) and Group II (100 consecutive adult participants without a history of stroke or any structural heart disease). We measured the maximal LA volume index (Max LAVI) and minimal LA volume index (Min LAVI). We calculated the left atrial ejection fraction (LAEF). All the participants were subjected to ABPM.
In our prospective, cross-sectional cohort study, the patients in Group I had statistically significantly higher Min LAVI and Max LAVI and Less LA EF than Group II, with a P value of (0.001, 0.001, and 0.008), respectively. The Group I patients had higher BPV as measured by SD parameters than patients in Group II, with a P value of 0.001 for all SD parameters. The BPV parameters, as measured by SD parameters, were positively related to the LA remodeling parameters in both groups. After adjusting all variables, we found that age, night systolic SD, and night diastolic SD parameters were independent predictors of LA remodeling.
The patients with cryptogenic stroke had higher short-term BPV, Min LAVI, and Max LAVI but lower LA EF. Careful monitoring of BPV may be of value for both primary and secondary preventions of ischemic stroke.
夜间血压变异性（BPV）增加与中风相关。左心房（LA）扩大是结构重塑的典型临床特征，常因左心房压力和容量过载而发生。血压已被证明是左心房扩大的重要决定因素。我们旨在评估BPV作为隐源性中风危险因素的影响，强调在这些患者的检查中纳入（APBM）的重要性，并测试这些患者中BPV与左心房重塑之间的关系，这可作为在其检查中增加动态血压监测的线索。此外，左心房重塑可能是隐匿性心房颤动（AF）的基础。我们纳入了第一组（108例连续的隐源性缺血性中风患者）和第二组（100例连续的无中风病史或任何结构性心脏病的成年参与者）。我们测量了最大左心房容积指数（Max LAVI）和最小左心房容积指数（Min LAVI）。我们计算了左心房射血分数（LAEF）。所有参与者均接受动态血压监测（ABPM）。
在我们的前瞻性横断面队列研究中，第一组患者的Min LAVI和Max LAVI在统计学上显著高于第二组，左心房射血分数低于第二组，P值分别为（0.001、0.001和0.008）。通过标准差参数测量，第一组患者的BPV高于第二组患者，所有标准差参数的P值均为0.001。通过标准差参数测量的BPV参数与两组的左心房重塑参数呈正相关。调整所有变量后，我们发现年龄、夜间收缩压标准差和夜间舒张压标准差参数是左心房重塑的独立预测因素。
隐源性中风患者的短期BPV、Min LAVI和Max LAVI较高，但左心房射血分数较低。仔细监测BPV可能对缺血性中风的一级和二级预防均有价值。
