Department of Neurology and Stroke Center La Paz University Hospital. La Paz University Hospital Research Institute (IdiPAZ). Universidad Autónoma de Madrid Madrid Spain.
Robotic and Cardiac Electrophysiology Unit, Department of Cardiology La Paz University Hospital. La Paz University Hospital Research Institute (IdiPAZ). Universidad Autónoma de Madrid Madrid Spain.
J Am Heart Assoc. 2024 Sep 3;13(17):e036236. doi: 10.1161/JAHA.124.036236. Epub 2024 Aug 29.
Unknown cardioembolic sources are frequent causes of cryptogenic stroke. We analyzed the risk of atrial fibrillation (AF) or high burden of ectopic atrial activity (HBEA) in patients with cryptogenic stroke, assessing atrial function and 1-year outcomes.
The ARIES (Atrial Imaging and Cardiac Rhythm in Cryptogenic Embolic Stroke) study is an observational study including patients with cryptogenic stroke. We analyzed the frequency of AF and HBEA (>3000 atrial ectopic beats/day or >2 bursts or atrial tachycardia between 3 beats and ≤30 seconds) in two 30-day Holter-ECGs, comparing advanced echocardiography signs of left atrial (LA) dysfunction according to rhythm: AF, HBEA, and normal sinus rhythm. We also evaluated 1-year stroke recurrence and mortality. The study included 109 patients; 35 (32.1%) patients had AF, 27 (24.8%) HBEA, and 47 (43.1%) normal sinus rhythm. Compared with those with normal sinus rhythm, patients with AF presented higher 2-dimensional and 3-dimensional LA indexed volumes (38.8±11.2 versus 27.3±11.8 mL/m, and 50.6±17.2 versus 34.0±15.4 mL/m, respectively, <0.001), lower 3-dimensional LA ejection fraction (50±14.6 versus 62.7±11.8, =0.001), LA reservoir strain (22.0±8.6 versus 30.4±10.5, <0.001), and LA contraction strain (10.5±8.18 versus 17.1±7.5, <0.001), remaining significant in multivariate analysis. Patients with HBEA showed higher LA indexed volumes and lower LA reservoir strain than patients with normal sinus rhythm only in univariate analysis. There were no differences in ischemic recurrence or mortality among the groups.
Patients with cryptogenic stroke showed a high incidence of AF and HBEA. AF is strongly related to LA volume, LA function, and LA reservoir and contraction strain, whereas HBEA showed milder structural changes. Advanced LA echocardiography could help patient selection for long-term ECG monitoring in suspected cardiac sources.
不明心源性栓塞源是隐源性卒中的常见病因。我们分析了隐源性卒中患者发生心房颤动（AF）或异位心房活动负荷增加（HBEA）的风险，评估了心房功能和 1 年结局。
ARIES（隐源性栓塞性卒中的心房成像和心律）研究是一项观察性研究，纳入了隐源性卒中患者。我们在两次 30 天动态心电图中分析了 AF 和 HBEA（>3000 个心房异位搏动/天或>2 次或 3 次至≤30 秒的房性心动过速）的发生率，并根据节律比较了左心房（LA）功能障碍的高级超声心动图征象：AF、HBEA 和正常窦性节律。我们还评估了 1 年卒中复发和死亡率。该研究纳入了 109 例患者；35 例（32.1%）患者为 AF，27 例（24.8%）为 HBEA，47 例（43.1%）为正常窦性节律。与正常窦性节律患者相比，AF 患者的 2 维和 3 维 LA 指数容积更大（38.8±11.2 与 27.3±11.8 ml/m，50.6±17.2 与 34.0±15.4 ml/m，均<0.001），3 维 LA 射血分数更低（50±14.6 与 62.7±11.8，=0.001），LA 储备应变更低（22.0±8.6 与 30.4±10.5，<0.001），LA 收缩应变更低（10.5±8.18 与 17.1±7.5，<0.001），多变量分析仍有意义。仅在单变量分析中，HBEA 患者的 LA 指数容积更高，LA 储备应变更低。各组之间缺血性复发或死亡率无差异。
隐源性卒中患者 AF 和 HBEA 的发生率较高。AF 与 LA 容积、LA 功能、LA 储备和收缩应变密切相关，而 HBEA 仅显示出轻度结构变化。高级 LA 超声心动图有助于选择疑似心脏源患者进行长期心电图监测。
