Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital - Roskilde, Roskilde, Denmark.
Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital - Bispebjerg, Copenhagen, Denmark.
Am J Cardiol. 2023 Oct 15;205:457-464. doi: 10.1016/j.amjcard.2023.08.042. Epub 2023 Sep 2.
Morphology-voltage-P-wave-duration (MVP) score combining P-wave duration (PWD), P-wave voltage in lead I (PWVI), and interatrial block (IAB) has been demonstrated to predict atrial fibrillation (AF). Therefore, this study aimed to examine MVP score and its P-wave components as potential predictors of AF screening effects on stroke prevention. This was a secondary analysis of the LOOP Study (Atrial Fibrillation detected by Continuous ECG Monitoring using Implantable Loop Recorder to prevent Stroke in High-risk Individuals) which randomized older persons (aged 70 to 90 years) with additional stroke risk factors to either continuous monitoring with implantable loop recorder and anticoagulation upon detection of AF episodes ≥6 minutes (the intervention group), or usual care. A total of 5,759 participants were included in the present analysis, where PWD, PWVI, and IAB were determined through a computerized analysis of 12-lead electrocardiogram and further employed to calculate baseline MVP score (0 to 6) for each participant. In total, 305 (5.3%) had stroke or systemic embolism during follow-up, with a higher risk in the group with MVP score 5 to 6 than those having score 0 to 2 (hazard ratio (HR) 1.54 [95% confidence interval (CI) 1.01 to 2.35]). This risk increase was mainly upheld by participants with IAB (HR 1.62 [95% CI 1.11 to 2.36] for IAB vs no IAB) and with longer PWD (HR 1.37 [95% CI 1.07 to 1.75] for >110 vs ≤110 ms). Compared with usual care, implantable loop recorder screening did not significantly reduce the risk of stroke or systemic embolism in any MVP risk categories (HR 0.80 [95% CI 0.60 to 1.08] for MVP score 0 to 2, 0.54 [95% CI 0.16 to 1.85] for MVP score 3 to 4, and 0.89 [95% CI 0.35 to 2.25] for MVP score 5 to 6; p = 0.78). In conclusion, a higher MVP score was associated with an increased stroke risk, but it did not demonstrate an association with effects of AF screening on stroke prevention. These findings should be considered hypothesis-generating and warrant further study.
形态-电压-P 波持续时间（MVP）评分结合 P 波持续时间（PWD）、I 导联的 P 波电压（PWVI）和房间传导阻滞（IAB）已被证明可预测心房颤动（AF）。因此，本研究旨在探讨 MVP 评分及其 P 波成分作为 AF 筛查对卒中预防效果的潜在预测因子。这是 LOOP 研究（使用植入式环路记录器通过连续心电图监测检测心房颤动以预防高危个体中风）的二次分析，该研究将年龄在 70 至 90 岁之间的伴有其他卒中危险因素的老年人随机分为连续监测组（植入式环路记录器监测和 AF 发作时检测到的抗凝治疗≥6 分钟）或常规护理组。本分析共纳入 5759 名参与者，通过计算机分析 12 导联心电图确定 PWD、PWVI 和 IAB，并进一步用于计算每位参与者的基线 MVP 评分（0 至 6）。在随访期间，共有 305 名（5.3%）发生了卒中或全身性栓塞，MVP 评分为 5 至 6 的组比 MVP 评分为 0 至 2 的组风险更高（危险比（HR）为 1.54 [95%置信区间（CI）为 1.01 至 2.35]）。这种风险增加主要是由存在 IAB（HR 1.62 [95%CI 1.11 至 2.36] 与无 IAB 相比）和 PWD 较长（HR 1.37 [95%CI 1.07 至 1.75] 与>110 与≤110ms 相比）的参与者维持的。与常规护理相比，植入式环路记录器筛查并未显著降低任何 MVP 风险类别中的卒中或全身性栓塞风险（MVP 评分 0 至 2 的 HR 为 0.80 [95%CI 0.60 至 1.08]，MVP 评分 3 至 4 的 HR 为 0.54 [95%CI 0.16 至 1.85]，MVP 评分 5 至 6 的 HR 为 0.89 [95%CI 0.35 至 2.25]；p=0.78）。总之，较高的 MVP 评分与卒中风险增加相关，但与 AF 筛查对卒中预防的效果无关。这些发现应被视为产生假说，并需要进一步研究。
