Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cardiocerebrovascular Diseases (PEC2), University of Burgundy, Dijon, France.
Department of Neuroimaging, University Hospital of Dijon, Dijon, France.
Neuroepidemiology. 2024;58(4):284-291. doi: 10.1159/000538249. Epub 2024 Mar 12.
Atrial fibrillation (AF) is frequently diagnosed during the acute stage of ischemic stroke (IS), and it may reflect undiagnosed AF before stroke, thus representing a missed opportunity for stroke prevention. This population-based study aimed to assess the prevalence of known AF (KAF) and AF diagnosed early after IS (AFDAS) and to compare clinical and brain/arterial imaging characteristics between patients.
Among patients with acute IS recorded in the population-based Dijon Stroke Registry, France (2013-2020), we identified those with KAF or AFDAS. AFDAS was considered when AF was diagnosed during the initial work-up based on electrocardiograms, in-hospital continuous electrocardiographic and/or Holter monitoring. Clinical and imaging characteristics on brain CT scan or angio-CT scan when available including old parenchymal lesions, arterial territory of the index IS, and aortic arch, cervical and intracranial arteries atheroma were compared between groups (KAF vs. AFDAS). Regression logistic models were used to assess factors associated with AFDAS (compared to KAF).
Among 1,756 IS patients, 550 (31.3%) had AF (mean age: 83.6 ± 10.3 years old, 60.5% women), of whom 367 (66.7%) presented with KAF and 183 (33.3%) had AFDAS. In multivariable model, hypertension (OR = 0.37; 95% CI: 0.21-0.64, p < 0.001), chronic heart failure (OR = 0.34; 95% CI: 0.18-0.67, p = 0.002), previous stroke (OR = 0.42; 95% CI: 0.26-0.67, p < 0.001), and preexisting dementia (OR = 0.36; 95% CI: 0.21-0.63, p < 0.001) were inversely associated with AFDAS, whereas NIHSS score was associated with AFDAS (OR = 1.02; 95% CI: 1.00-1.05, p = 0.012).
Our findings indicate a more advanced stage of the atrial cardiomyopathy in KAF as compared with AFDAS patients and may thus contribute to the fact that in these latter patients AF had not been diagnosed prior to stroke. This group of patients undeniably represents a missed opportunity for stroke prevention.
心房颤动（AF）在缺血性中风（IS）的急性期经常被诊断出来，它可能反映了中风前未被诊断出的 AF，因此代表了预防中风的机会错失。这项基于人群的研究旨在评估已知 AF（KAF）和中风后早期 AF（AFDAS）的患病率，并比较患者之间的临床和脑/动脉成像特征。
在法国第戎中风登记处（2013-2020 年）记录的急性 IS 患者中，我们确定了那些有 KAF 或 AFDAS 的患者。当根据心电图、住院期间连续心电图和/或动态心电图监测在初始检查期间诊断出 AF 时，考虑 AFDAS。当有脑 CT 扫描或血管 CT 扫描时，比较两组之间的临床和影像学特征（KAF 与 AFDAS），包括陈旧性脑实质病变、指数 IS 的动脉区域、主动脉弓、颈椎和颅内动脉粥样硬化。回归逻辑模型用于评估与 AFDAS 相关的因素（与 KAF 相比）。
在 1756 名 IS 患者中，有 550 名（31.3%）患有 AF（平均年龄：83.6±10.3 岁，60.5%为女性），其中 367 名（66.7%）为 KAF，183 名（33.3%）为 AFDAS。在多变量模型中，高血压（OR=0.37；95%CI：0.21-0.64，p < 0.001）、慢性心力衰竭（OR=0.34；95%CI：0.18-0.67，p=0.002）、既往中风（OR=0.42；95%CI：0.26-0.67，p < 0.001）和预先存在的痴呆症（OR=0.36；95%CI：0.21-0.63，p < 0.001）与 AFDAS 呈负相关，而 NIHSS 评分与 AFDAS 相关（OR=1.02；95%CI：1.00-1.05，p=0.012）。
我们的研究结果表明，与 AFDAS 患者相比，KAF 患者心房心肌病的晚期更为明显，因此可能导致这些患者在中风前未被诊断出 AF。这群患者无疑代表了预防中风的机会错失。
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