Alonso Angelika, Kraus Josephine, Ebert Anne, Nikolayenko Valeriya, Kruska Mathieu, Sandikci Vesile, Lesch Hendrik, Duerschmied Daniel, Platten Michael, Baumann Stefan, Szabo Kristina, Akin Ibrahim, Fastner Christian
Department of Neurology, University Medical Centre Mannheim and Mannheim Centre for Translational Neurosciences, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Front Neurol. 2023 Sep 27;14:1237550. doi: 10.3389/fneur.2023.1237550. eCollection 2023.
Left atrial (LA) enlargement has been repeatedly shown to be associated with the diagnosis of atrial fibrillation (AF). In clinical practice, several parameters are available to determine LA enlargement: LA diameter index (LADI), LA area index (LAAI), or LA volume index (LAVI). We investigated the predictive power of these individual LA parameters for AF in patients with acute ischemic stroke or transient ischemic attack (TIA).
LAETITIA is a retrospective observational study that reflects the clinical reality of acute stroke care in Germany. Consecutive patient cases with acute ischemic cerebrovascular event (CVE) in 2019 and 2020 were identified from the Mannheim stroke database. Predictive power of each LA parameter was determined by the area under the curve (AUC) of receiver operating characteristic curves. A cutoff value was determined. A multiple logistic regression analysis was performed to confirm the strongest LA parameter as an independent predictor of AF in patients with acute ischemic CVE.
A total of 1,910 patient cases were included. In all, 82.0% of patients had suffered a stroke and 18.0% had a TIA. Patients presented with a distinct cardiovascular risk profile (reflected by a CHADS-VASc score ≥2 prior to hospital admission in 85.3% of patients) and were moderately affected on admission [median NIHSS score 3 (1; 8)]. In total, 19.5% of patients had pre-existing AF, and 8.0% were newly diagnosed with AF. LAAI had the greatest AUC of 0.748, LADI of 0.706, and LAVI of 0.719 (each < 0.001 vs. diagonal line; AUC-LAAI vs. AUC-LADI = 0.030, AUC-LAAI vs. AUC-LAVI = 0.004). LAAI, increasing NIHSS score on admission, and systolic heart failure were identified as independent predictors of AF in patients with acute ischemic CVE. To achieve a clinically relevant specificity of 70%, a cutoff value of ≥10.3 cm/m was determined for LAAI (sensitivity of 69.8%).
LAAI revealed the best prediction of AF in patients with acute ischemic CVE and was confirmed as an independent risk factor. An LAAI cutoff value of 10.3 cm/m could serve as an inclusion criterion for intensified AF screening in patients with embolic stroke of undetermined source in subsequent studies.
左心房（LA）扩大已多次被证明与心房颤动（AF）的诊断相关。在临床实践中，有多个参数可用于确定LA扩大：LA直径指数（LADI）、LA面积指数（LAAI）或LA容积指数（LAVI）。我们研究了这些LA个体参数对急性缺血性卒中或短暂性脑缺血发作（TIA）患者发生AF的预测能力。
LAETITIA是一项回顾性观察性研究，反映了德国急性卒中治疗的临床实际情况。从曼海姆卒中数据库中识别出2019年和2020年连续发生急性缺血性脑血管事件（CVE）的患者病例。每个LA参数的预测能力通过接受者操作特征曲线的曲线下面积（AUC）来确定。确定了一个临界值。进行多因素逻辑回归分析，以确认最强的LA参数作为急性缺血性CVE患者发生AF的独立预测因素。
共纳入1910例患者病例。总体而言，82.0%的患者发生了卒中，18.0%的患者发生了TIA。患者呈现出明显的心血管风险特征（85.3%的患者入院前CHADS-VASc评分≥2反映了这一点），入院时受影响程度中等[美国国立卫生研究院卒中量表（NIHSS）评分中位数为3（1；8）]。总体而言，19.5%的患者既往有AF，8.0%的患者新诊断为AF。LAAI的AUC最大，为0.748，LADI为0.706，LAVI为0.719（与对角线相比，各P<0.001；AUC-LAAI与AUC-LADI比较=0.030，AUC-LAAI与AUC-LAVI比较=0.004）。LAAI、入院时NIHSS评分增加和收缩性心力衰竭被确定为急性缺血性CVE患者发生AF的独立预测因素。为达到70%的临床相关特异性，确定LAAI的临界值≥10.3 cm/m²（敏感性为69.8%）。
LAAI对急性缺血性CVE患者发生AF的预测最佳，并被确认为独立危险因素。在后续研究中，10.3 cm/m²的LAAI临界值可作为对不明来源栓塞性卒中患者加强AF筛查的纳入标准。
