Neurology Department, Hospital Beatriz Ângelo, Loures, Portugal.
Neurology Department, Hospital São Bernardo, Setúbal, Portugal.
J Stroke Cerebrovasc Dis. 2023 Oct;32(10):107299. doi: 10.1016/j.jstrokecerebrovasdis.2023.107299. Epub 2023 Aug 30.
The recommended cardiac rhythm evaluation to determine the etiology of ischemic stroke (IS) is similar in all patients regardless of their age and includes an electrocardiogram and at least a 24-hour heart rhythm monitoring. However, it is known that the main causes of IS vary according to patients' age. There is a higher preponderance of arterial dissections and patent foramen ovale in younger patients, while atrial fibrillation (AF) is more common in older patients.
To determine the proportion of AF in young IS reported in the literature and determine if young IS patients found to have AF had known structural cardiac pathology.
Systematic review of the literature searching PubMed and Embase for articles published since their inception to August 2020. Inclusion criteria were studies including at least 10 patients, aged 14-50 years-old, clinical or radiological diagnosis of IS and quantification of patients found to have AF. We conducted a meta-analysis using a random-effects model and calculated pooled proportions with 95% confidence intervals.
8331 articles were screened, 154 were selected for full-text review. 43 studies were included in our final analysis (902800 patients). The proportion of AF in young IS overall was 3.1% [95%CI 2.4-3.7], I 93.88%. Sub-analysis revealed a proportion of AF of 3.8% [95% CI 0.3-7.3] in lower-middle-income economies, versus 5.4% [95% CI 3-7.9] in upper-middle-income economies, and 2.2% [95% CI 1.6-2.8] in high-income economies. Only 3 studies mentioned the proportion of patients with AF that had structural cardiac pathology.
The proportion of AF in young IS was low. More studies are needed to better understand if young IS patients diagnosed with AF had a priori known structural cardiac pathology that could increase the probability of finding AF. This could lead to a reevaluation of the need for 24 hours cardiac rhythm evaluation in young patients without cardiac pathology.
推荐对所有患者（无论年龄大小）进行心脏节律评估以确定缺血性卒中（IS）的病因，这包括心电图和至少 24 小时的心律监测。然而，已知 IS 的主要病因因患者年龄而异。在年轻患者中，动脉夹层和卵圆孔未闭的比例较高，而在老年患者中，房颤（AF）更为常见。
确定文献中报道的年轻 IS 中 AF 的比例，并确定年轻 IS 患者中发现 AF 是否存在已知结构性心脏病理学。
系统检索 PubMed 和 Embase 数据库中自成立以来至 2020 年 8 月发表的文献，纳入标准为纳入至少 10 例患者，年龄 14-50 岁，临床或影像学诊断为 IS 并定量评估发现 AF 的患者的研究。我们使用随机效应模型进行荟萃分析，并计算合并的比例及其 95%置信区间。
共筛选出 8331 篇文章，其中 154 篇文章进行了全文审查。最终分析纳入 43 项研究（902800 例患者）。总体而言，年轻 IS 患者中 AF 的比例为 3.1%[95%CI 2.4-3.7]，I 93.88%。亚组分析显示，中低收入经济体 AF 的比例为 3.8%[95%CI 0.3-7.3]，中上收入经济体为 5.4%[95%CI 3-7.9]，高收入经济体为 2.2%[95%CI 1.6-2.8]。仅有 3 项研究提到了 AF 患者中存在结构性心脏病理学的比例。
年轻 IS 患者中 AF 的比例较低。需要更多的研究来更好地了解诊断为 AF 的年轻 IS 患者是否存在可增加发现 AF 概率的先存结构性心脏病理学。这可能导致重新评估年轻患者是否需要进行 24 小时心脏节律评估，前提是他们没有心脏病理学。
