Virk Sohaib A, Ho William W H, Takeuchi Fumihiko, Morris Gwilym M, Kistler Peter M, Kalman Jonathan
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia.
Baker Heart and Diabetes Institute, Melbourne, Australia; Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Australia.
Heart Rhythm. 2025 Sep;22(9):e668-e675. doi: 10.1016/j.hrthm.2025.04.055. Epub 2025 Apr 30.
Emerging evidence indicates sinus node dysfunction (SND) may be an important marker of a biatrial myopathy. However, the relative risk of ischemic stroke in isolated SND has not been clearly delineated in comparative prospective studies.
This study examined the association between SND (with and without concomitant atrial fibrillation [AF]) and ischemic stroke (IS) in the UK Biobank.
The UK Biobank is a prospective, population-based cohort of >500,000 individuals aged 40-69 years recruited across the United Kingdom between 2006 and 2010, with follow-up extending beyond 10 years. Incident health events were longitudinally tracked through electronic health record linkages with hospital admissions, primary care records, and death registration data using International Classification of Diseases, Tenth Revision coding. Individuals with SND, AF, or both were identified. Patients with prosthetic heart valves, rheumatic mitral valve diseases, mitral stenosis, and prior IS were excluded. The primary end point was time to IS.
Of the 451,493 participants (median age 57 years, 44.2% male) included in this study: 593 had isolated SND, 955 had combined SND and AF, 37,065 had isolated AF, and 412,880 comprised controls with neither SND nor AF. During a median follow-up of 13.2 years, yearly IS incidence was 0.37%, 0.60%, 0.59%, and 0.10% in these groups, respectively. In multivariable competing-risk regression modeling accounting for death, isolated SND conferred a significantly increased risk of IS compared to controls (subdistribution hazard ratio 2.28; 95% confidence interval, 1.57-3.31; P < .001). Participants with AF and SND had a similar risk of IS, compared to those with isolated AF (subdistribution hazard ratio 1.07; 95% confidence interval, 0.84-1.37; P = .58).
SND is an independent risk marker for the development of IS in individuals without AF. This provides further evidence of SND being an electrical marker of a biatrial myopathy.
新出现的证据表明，窦房结功能障碍（SND）可能是双房心肌病的一个重要标志物。然而，在比较性前瞻性研究中，孤立性SND患者发生缺血性卒中的相对风险尚未明确界定。
本研究在英国生物银行中探讨了SND（伴或不伴心房颤动[AF]）与缺血性卒中（IS）之间的关联。
英国生物银行是一个基于人群的前瞻性队列，于2006年至2010年在英国招募了超过50万名年龄在40 - 69岁之间的个体，随访时间超过10年。通过与医院入院记录、初级保健记录和死亡登记数据进行电子健康记录链接，并使用国际疾病分类第十版编码，纵向跟踪新发健康事件。确定患有SND、AF或两者皆有的个体。排除患有人工心脏瓣膜、风湿性二尖瓣疾病、二尖瓣狭窄和既往有IS的患者。主要终点是发生IS的时间。
本研究纳入的451,493名参与者（中位年龄57岁，44.2%为男性）中：593人患有孤立性SND，955人患有SND合并AF，37,065人患有孤立性AF，412,880人作为既无SND也无AF的对照组。在中位随访13.2年期间，这些组的年IS发病率分别为0.37%、0.60%、0.59%和0.10%。在考虑死亡因素的多变量竞争风险回归模型中，与对照组相比，孤立性SND使IS风险显著增加（亚分布风险比2.28；95%置信区间，1.57 - 3.31；P <.001）。与孤立性AF患者相比，AF合并SND患者发生IS的风险相似（亚分布风险比1.07；95%置信区间，0.84 - 1.37；P = 0.58）。
SND是无AF个体发生IS的独立风险标志物。这为SND作为双房心肌病的电标志物提供了进一步证据。
