Division of Cardiology, Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany.
Division of Neurology, Medical Faculty, Heinrich-Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany.
Heart Vessels. 2023 Apr;38(4):543-550. doi: 10.1007/s00380-022-02189-7. Epub 2022 Oct 20.
The total atrial conduction time (TACT) measured by echocardiography predicts the risk of atrial fibrillation (AF). This study aimed to investigate whether adding the TACT to the revised Framingham stroke risk profile (rFSRP) improves the efficacy of predicting stroke incidence in patients without prior stroke or known AF. The TACT was measured in 376 consecutive patients > 18 years (58.5 ± 16.3 years; 46% male) receiving echocardiography without any prior history of stroke or AF. The primary endpoint was the occurrence of ischemic stroke, and the secondary endpoint was any documentation of AF during the 2 years of follow-up. During the follow-up period, ischemic strokes occurred in 10 patients (2.65%), and AF in 22 patients (5.85%). The TACT was significantly longer in those who later had a stroke compared with those who did not (169.4 vs. 142.7 ms, p < 0.001). Both rFSRP and TACT predicted the risk for stroke incidence. The univariate model showed that the TACT was a predictor of ischemic stroke incidence (p < 0.001; hazard ratio of 1.94 for every 10 ms; 95% confidence interval, 1.49-2.54). The addition of TACT to rFSRP significantly improved the area under the receiver operating characteristic curve (0.79 vs. 0.85, p = 0.001). Stroke risk prediction was significantly improved by the addition of TACT to rFSRP. The utility of the TACT should be further investigated in large-scale randomized clinical trials.
经超声心动图测量的总心房传导时间（TACT）可预测心房颤动（AF）的风险。本研究旨在探讨在无既往卒中或已知 AF 病史的患者中，将 TACT 加入修订后的 Framingham 卒中风险评分（rFSRP）是否能提高预测卒中发生率的效果。共纳入 376 例连续接受超声心动图检查且年龄>18 岁的患者（58.5±16.3 岁；46%为男性），这些患者均无既往卒中或 AF 病史。主要终点是缺血性卒中的发生，次要终点是在 2 年随访期间任何 AF 的记录。在随访期间，10 例患者（2.65%）发生缺血性卒中，22 例患者（5.85%）发生 AF。与未发生卒中的患者相比，发生卒中的患者 TACT 明显更长（169.4 比 142.7 ms，p<0.001）。rFSRP 和 TACT 均预测了卒中发生的风险。单变量模型显示，TACT 是缺血性卒中发生的预测因子（p<0.001；每增加 10 ms 的风险比为 1.94；95%置信区间，1.49-2.54）。将 TACT 加入 rFSRP 显著提高了受试者工作特征曲线下面积（0.79 比 0.85，p=0.001）。TACT 的加入显著改善了 rFSRP 的卒中风险预测效果。TACT 的效用应在大规模随机临床试验中进一步研究。
