Performance of Atrial Fibrillation Burden Trends for Stroke Risk Stratification.

IF 9.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Jonathan P Piccini, Evan J Stanelle, Cody C Johnson, Elaine M Hylek, Rahul Kanwar, Dhanunjaya R Lakkireddy, Suneet Mittal, James Peacock, Andrea M Russo, Dana Soderlund, Mellanie True Hills, Rod S Passman
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引用次数: 0

Abstract

Background: Atrial fibrillation (AF) is associated with an increased risk of stroke, yet the limitations of conventional monitoring have restricted our understanding of AF burden risk thresholds. Predictive algorithms incorporating continuous AF burden measures may be useful for predicting stroke. This study evaluated the performance of temporal AF burden trends as predictors of stroke from a large cohort with insertable cardiac monitors.

Methods: Using deidentified data from Optum Clinformatics Data Mart (2007-2019) linked with the Medtronic CareLink insertable cardiac monitor database, we identified patients with an insertable cardiac monitor for AF management (n=1197), suspected AF (n=1611), and cryptogenic stroke (n=2205). Daily AF burden was transformed into simple moving averages, and temporal AF burden trends were defined as the comparison of unique simple moving average pairs. Classification trees were used to predict ischemic stroke, and AF burden significance was quantified using bootstrapped mean variable importance.

Results: Of 5013 patients (age, 69.2±11.7 years; 50% male; CHA2DS2-VASc, 3.7±1.9) who met inclusion criteria, 869 had an ischemic stroke over 2 409 437 days total follow-up. Prior stroke or transient ischemic attack (variable importance, 13.13) was the number 1 predictor of future stroke followed by no prior diagnosis of AF (7.35) and AF burden trends in follow-up (2.59). Temporal proximity of AF and risk of stroke differed by device indication (simple moving averages: AF management, <8 days and suspected AF and cryptogenic stroke, 8-21 days). Together, baseline characteristics and AF burden trends performed optimally for the area under the receiver operating characteristic curve (0.73), specificity (0.70), and relative risk (5.00).

Conclusions: AF burden trends may provide incremental prognostic value as leading indicators of stroke risk compared with conventional schemes.

心房颤动负担趋势在中风风险分层中的表现。
背景:心房颤动(房颤)与中风风险增加有关,但传统监测的局限性限制了我们对房颤负荷风险阈值的了解。结合连续房颤负荷测量的预测算法可能有助于预测中风。本研究评估了使用可插入式心脏监护仪的大型队列中作为中风预测指标的时间性房颤负荷趋势的性能:使用与美敦力 CareLink 插入式心脏监护仪数据库相连接的 Optum Clinformatics Data Mart(2007-2019 年)中的去身份化数据,我们确定了使用插入式心脏监护仪进行房颤管理(n=1197)、疑似房颤(n=1611)和隐源性中风(n=2205)的患者。将每日房颤负荷转换为简单移动平均值,并通过比较独特的简单移动平均值对来定义时间性房颤负荷趋势。分类树用于预测缺血性中风,房颤负荷的重要性通过引导平均变量重要性进行量化:符合纳入标准的 5013 名患者(年龄为 69.2±11.7 岁;50% 为男性;CHA2DS2-VASc 为 3.7±1.9)中,有 869 人在 2 409 437 天的随访中发生了缺血性卒中。既往中风或短暂性脑缺血发作(重要度可变,13.13)是预测未来中风的首要因素,其次是既往未确诊房颤(7.35)和随访中房颤负担趋势(2.59)。心房颤动与中风风险的时间接近程度因设备适应症而异(简单移动平均值、简单移动平均值、简单移动平均值、简单移动平均值、简单移动平均值、简单移动平均值、简单移动平均值、简单移动平均值):房颤管理,结论:与传统方案相比,房颤负荷趋势作为中风风险的先导指标,可能具有更高的预后价值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
13.70
自引率
4.80%
发文量
187
审稿时长
4-8 weeks
期刊介绍: Circulation: Arrhythmia and Electrophysiology is a journal dedicated to the study and application of clinical cardiac electrophysiology. It covers a wide range of topics including the diagnosis and treatment of cardiac arrhythmias, as well as research in this field. The journal accepts various types of studies, including observational research, clinical trials, epidemiological studies, and advancements in translational research.
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