Department of Medicine, Oman Medical Specialty Board, Muscat, Oman.
Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman.
Sultan Qaboos Univ Med J. 2023 Aug;23(3):351-359. doi: 10.18295/squmj.12.2022.070. Epub 2023 Aug 28.
Strokes are a major cause of morbidity and mortality. This study aimed to evaluate the effectiveness of routine cardiac investigations in identifying a cardioembolic aetiology for ischaemic strokes.
This retrospective study involved patients who presented with a stroke to the Sultan Qaboos University Hospital, Muscat, Oman, between January and December 2019.
A total of 183 patients (mean age = 66.2 ± 13.5 years), the majority of which were male (n = 109, 59.6%), were included. The common risk factors included hypertension (74.9%), diabetes (61.7%) and hyperlipidaemia (54.6%). The middle cerebral artery was the most common artery affected, in 44 patients (24.0%). On admission, 14 (7.6%) patients were in atrial fibrillation (AF), while the rest were in sinus rhythm. The 24-hour electrocardiogram (ECG) Holter monitoring revealed no abnormalities in 135 patients. AF was observed in 15 (8.1%) patients (inclusive of the 14 who had AF on resting ECG). Furthermore, 32 (17.4%) patients had evidence of non-sustained atrial arrhythmia, and nine (4.9%) had non-sustained ventricular tachycardia. Frequent supraventricular ectopics (>30/hour) was noted on 30 patients (16.3%), while five (2.7%) patients had a high ventricular ectopic burden (>10% burden). No significant abnormalities were noted in the echocardiograms of the patients; however, 10 out of 132 (7.5%) patients presented a positive bubble echo. Enlarged left atria were found in 24 (13.1%) patients.
The overall diagnostic yield of the abnormalities from routine cardiac testing for patients with stroke appears to be low. Targeted screening of patients with cryptogenic stroke, as suggested by newer guidelines, is recommended.
中风是发病率和死亡率的主要原因。本研究旨在评估常规心脏检查在确定缺血性中风心源性病因方面的有效性。
这是一项回顾性研究，纳入了 2019 年 1 月至 12 月期间在阿曼马斯喀特苏丹卡布斯大学医院就诊的中风患者。
共纳入 183 例患者（平均年龄=66.2±13.5 岁），其中大多数为男性（n=109，59.6%）。常见的危险因素包括高血压（74.9%）、糖尿病（61.7%）和高脂血症（54.6%）。最常见的受影响动脉是大脑中动脉，有 44 例患者（24.0%）。入院时，14 例（7.6%）患者为心房颤动（AF），其余患者为窦性心律。24 小时心电图（ECG）动态监测在 135 例患者中未发现异常。在休息心电图中发现 AF 的 15 例（8.1%）患者（包括 14 例 AF 患者）中观察到 AF。此外，32 例（17.4%）患者有非持续性房性心律失常证据，9 例（4.9%）患者有非持续性室性心动过速。30 例患者（16.3%）出现频发室上性早搏（>30/小时），5 例（2.7%）患者出现高室性早搏负荷（>10%负荷）。患者的超声心动图无明显异常，但 132 例患者中有 10 例（7.5%）呈阳性气泡回声。24 例患者（13.1%）左心房增大。
常规心脏检查对中风患者异常的总体诊断率似乎较低。建议按照新指南对隐源性中风患者进行有针对性的筛查。
