Höwel Dennis, Leitz Patrick, Frommeyer Gerrit, Ritter Martin A, Reinke Florian, Füting Anna, Reinsch Nico, Eckardt Lars, Kochhäuser Simon, Dechering Dirk G
Department of Cardiology, St. Marienhospital Vechta, Marienstr. 6-8, 49377 Vechta, Germany.
Department of Cardiology II-Electrophysiology, University Hospital Münster, 48149 Münster, Germany.
J Clin Med. 2023 Oct 17;12(20):6566. doi: 10.3390/jcm12206566.
-Electrocardiography (ECG) and echocardiographic left atrial (LA) parameters may be helpful to assess the risk of atrial fibrillation (AF) in embolic stroke of unknown etiology (ESUS) and could therefore guide intensity of ECG monitoring. -1153 consecutive patients with ischemic stroke or transient ischemic attack (TIA) were analyzed. An internal loop recorder (ILR) was implanted in 104 consecutive patients with ESUS. Multiple morphologic P-wave parameters in baseline 12-channel ECG and echocardiographic LA parameters were measured and analyzed in patients with and without ILR-detected AF. Using logistic regression, we evaluated the predictive value of several ECG parameters and LA dimensions on the occurrence of AF. -In 20 of 104 (19%) patients, AF was diagnosed by ILR during a mean monitoring time of 575 (IQR 470-580) days. Patients with AF were significantly older (72 (67-75) vs. 60 (52-72) years; = 0.001) and premature atrial contractions (PAC) were more frequently observed (40% vs. 2%; < 0.001) during baseline ECG. All morphologic P-wave parameters did not show a significant difference between groups. There was a non-significant trend towards a larger LA volume index (31 (24-36) vs. 29 (25-37) mL/m; = 0.09) in AF patients. -Age and PAC are independently associated with incident AF in ESUS and could be used as markers for selecting patients that may benefit from more extensive rhythm monitoring or ILR implantation. In our consecutive cohort of patients with ESUS, neither morphological P-wave parameters nor LA size were predictive of AF.
-心电图（ECG）和超声心动图左心房（LA）参数可能有助于评估不明病因栓塞性卒中（ESUS）患者发生心房颤动（AF）的风险，因此可指导心电图监测的强度。-对1153例连续的缺血性卒中或短暂性脑缺血发作（TIA）患者进行了分析。对104例连续的ESUS患者植入了体内环路记录仪（ILR）。在有和没有ILR检测到AF的患者中，测量并分析了基线12导联心电图中的多个形态学P波参数和超声心动图LA参数。使用逻辑回归，我们评估了几个心电图参数和LA大小对AF发生的预测价值。-在104例患者中的20例（19%）中，ILR在平均575（四分位间距470 - 580）天的监测时间内诊断出AF。AF患者明显年龄更大（72（67 - 75）岁 vs. 60（52 - 72）岁；P = 0.001），并且在基线心电图期间更频繁地观察到房性早搏（PAC）（40% vs. 2%；P < 0.001）。所有形态学P波参数在组间未显示出显著差异。AF患者的LA容积指数有增大的非显著趋势（31（24 - 36） vs. 29（25 - 37）mL/m²；P = 0.09）。-年龄和PAC与ESUS患者发生AF独立相关，可作为选择可能从更广泛的心律监测或ILR植入中获益的患者的标志物。在我们连续的ESUS患者队列中，形态学P波参数和LA大小均不能预测AF。
