Komatsu Teppei, Okumura Motohiro, Kida Hiroyuki, Takahashi Junichiro, Maku Takahiro, Kitagawa Tomomichi, Sato Takeo, Takatsu Hiroki, Sakuta Kenichi, Sakai Kenichiro, Umehara Tadashi, Mitsumura Hidetaka, Oseto Hirotsuna, Iguchi Yasuyuki
Department of Neurology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, Japan.
Department of Neurology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, Japan.
Int J Cardiol. 2024 Mar 15;399:131769. doi: 10.1016/j.ijcard.2024.131769. Epub 2024 Jan 9.
This study's objective is to investigate whether mild aortic arch plaque is associated with the development of atrial fibrillation (AF) in stroke patients with embolic stroke of undetermined source (ESUS) during the first year following the implantation of an insertable cardiac monitor (ICM).
The participants in this cross-sectional observational study were consecutive patients with ESUS, even after transesophageal echocardiography. We assessed the relationship between the thickness of the participants' aortic arch plaque and AF detected after ICM implantation.
Of the 50 consecutive patients with ESUS enrolled in this study, 12 (24%) developed AF. We observed that thicker aortic arch plaque was associated with undetected AF (2.3 mm vs. 1.2 mm, p < 0.001). Aortic arch plaque thickness was independent associated with undetected AF (OR 54.00, 95% CI 2.706-1077.544, p = 0.009). When the cut-off value for aortic arch plaque thickness was 1.8 mm, the sensitivity and specificity were 71.1% and 91.7%, respectively (95% CI = 0.75-0.98, p < 0.001). Also, patients having both aortic arch plaque with a thickness < 1.8 mm and a CHADS score ≥ 4 were more likely to have detectable AF than no AF (88% vs. 12%, p < 0.001).
A thinner aortic arch plaque was associated with the development of AF. Patients with mild aortic plaques below 4 mm but ≥1.8 mm in thickness and without other high-risk features are less likely to have paroxysmal AF on ICM, and these plaques may be a possible source of embolism for their strokes.
本研究的目的是调查在植入可插入式心脏监测器（ICM）后的第一年，轻度主动脉弓斑块是否与不明来源栓塞性卒中（ESUS）的卒中患者发生心房颤动（AF）有关。
本横断面观察性研究的参与者为连续的ESUS患者，即使经过经食管超声心动图检查。我们评估了参与者主动脉弓斑块厚度与ICM植入后检测到的AF之间的关系。
在本研究纳入的50例连续ESUS患者中，12例（24%）发生了AF。我们观察到，较厚的主动脉弓斑块与未检测到的AF相关（2.3毫米对1.2毫米，p<0.001）。主动脉弓斑块厚度与未检测到的AF独立相关（比值比54.00，95%置信区间2.706 - 1077.544，p = 0.009）。当主动脉弓斑块厚度的截断值为1.8毫米时，敏感性和特异性分别为71.1%和91.7%（95%置信区间 = 0.75 - 0.98，p<0.001）。此外，主动脉弓斑块厚度<1.8毫米且CHADS评分≥4的患者比未发生AF的患者更有可能检测到AF（88%对12%，p<0.001）。
较薄的主动脉弓斑块与AF的发生有关。厚度在4毫米以下但≥1.8毫米且无其他高危特征的轻度主动脉斑块患者，ICM检测到阵发性AF的可能性较小，这些斑块可能是其卒中的潜在栓塞来源。
