How is Ambulatory Electrocardiogram Predictive of Stroke in Atrial Fibrillation Patients?

IF 1.8 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiology Research and Practice Pub Date : 2022-10-10 eCollection Date: 2022-01-01 DOI:10.1155/2022/7619669

Xiuping Zhuo, Meinv Huang

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引用次数: 0

Abstract

Background: Atrial fibrillation (AF) is a significant stroke risk factor. Further research is needed to clarify whether higher atrial fibrillation burden (AFB) link to the elevated risk of ischemic embolism, and how AF burden could combine with CHA₂DS₂-VASc score to improve the anticoagulation strategy. We aim to evaluate if the AF burden characterized using 24-hours Holter ECG monitoring is associated with the risk of ischemic stroke.

Methods: This cohort study enrolled 210 Holter ECG monitoring detected atrial fibrillation patients. The burden of atrial fibrillation was defined as the percentage of time in atrial fibrillation during the monitoring period, and the AF burden and CHA₂DS₂-VASc score were compared between patients with and without thromboembolic outcomes. Multivariate regressions were conducted to estimate the predictors of thromboembolic outcomes.

Results: Eighteen thromboembolic events occurred within a median follow-up of 11.39 months. Patients with ischemic stroke had higher CHA₂DS₂-VASc scores but not higher AF burden. After adjusting for age, hypertension, diabetes, anticoagulation, antithrombotic therapy, AF burden, and AF with higher CHA₂DS₂-VASc score was associated with increased risk for ischemic stroke (hazard ratio (HR), 15.17). CHA₂DS₂-VASc score > 4.5 was a predictor of significantly higher risk of future stroke (AUC 0.92).

Conclusions: In Holter ECG monitoring detected AF, AF burden does not significantly impact the subsequent risk of stroke; whereas, CHA₂DS₂-VASc scoring is still a robust predictor of stroke risk. This may illustrate that once AF is detected from Holter ECG monitoring, underlying risk factors appear to be more predictive of subsequent stroke risk than atrial fibrillation burden.

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动态心电图如何预测心房颤动患者的中风？

背景：心房颤动（AF）是一个重要的卒中风险因素。需要进一步研究以明确较高的心房颤动负荷（AFB）是否与缺血性栓塞风险升高有关，以及心房颤动负荷如何与 CHA2DS2-VASc 评分相结合以改善抗凝策略。我们的目的是评估使用 24 小时 Holter 心电图监测表征的房颤负荷是否与缺血性中风风险相关：这项队列研究共纳入了 210 名通过 Holter 心电图监测发现心房颤动的患者。心房颤动负担定义为监测期间心房颤动时间的百分比，并比较了有血栓栓塞结局和无血栓栓塞结局患者的心房颤动负担和 CHA2DS2-VASc 评分。对血栓栓塞结果的预测因素进行了多变量回归估计：结果：在中位 11.39 个月的随访期间，发生了 18 起血栓栓塞事件。缺血性中风患者的 CHA2DS2-VASc 评分较高，但房颤负担并不重。在对年龄、高血压、糖尿病、抗凝、抗血栓治疗、房颤负荷进行调整后，CHA2DS2-VASc评分越高，缺血性中风的风险越高（危险比（HR）为15.17）。CHA2DS2-VASc 评分 > 4.5 是未来中风风险显著升高的预测因子（AUC 0.92）：结论：在 Holter 心电图监测发现房颤的患者中，房颤负荷对后续卒中风险没有显著影响；而 CHA2DS2-VASc 评分仍是卒中风险的可靠预测指标。这可能说明，一旦通过 Holter 心电图监测发现房颤，潜在风险因素似乎比房颤负荷更能预测后续卒中风险。

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来源期刊

Cardiology Research and Practice Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.40

自引率

0.00%

发文量

审稿时长

13 weeks

期刊介绍： Cardiology Research and Practice is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies that focus on the diagnosis and treatment of cardiovascular disease. The journal welcomes submissions related to systemic hypertension, arrhythmia, congestive heart failure, valvular heart disease, vascular disease, congenital heart disease, and cardiomyopathy.