{"title":"SAFAS 研究中缺血性中风后检测到的心房心肌病标记物的分布及其与心房颤动的关系。","authors":"Romain Didier, Lucie Garnier, Gauthier Duloquin, Alexandre Meloux, Audrey Sagnard, Mathilde Graber, Geoffrey Dogon, Karim Benali, Thibaut Pommier, Gabriel Laurent, Catherine Vergely, Yannick Bejot, Charles Guenancia","doi":"10.1136/svn-2023-002447","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Atrial cardiomyopathy (AC) is an emerging concept explaining the pathophysiology of cardioembolic strokes in absence of atrial fibrillation (AF). A definition based on the presence of electrical abnormality (P-wave terminal force in lead V1 (PTFV1) >5000 µV×ms), N-Terminal pro-B-type natriuretic peptide (NT pro BNP) >250 pg/mL and/or indexed left atrial diameter (LADI) >3 cm/m² is currently tested in the ARCADIA (AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke) trial. We set out to estimate the prevalence of AC as defined in the ARCADIA trial, its determinants and its association with AF detected after stroke (AFDAS).</p><p><strong>Methods: </strong>Stepwise screening for silent Atrial Fibrillation After Stroke (SAFAS) study prospectively included 240 ischaemic stroke patients. AC markers were complete for 192 of them and 9 were not included in this analysis because AF had been diagnosed on admission.</p><p><strong>Results: </strong>A total of 183 patients were analysed, of whom 57% (104 patients) met the AC criteria (79 NT-proBNP, 47 PTFV1, 4 LADI). In the multivariate logistic regression, C reactive protein >3 mg/L (OR (95% CI) 2.60 (1.30 to 5.21), p=0.007) and age (OR (95% CI) 1.07 (1.04 to 1.10), p<0.001) were found to be independently associated with AC. After 6 months of follow-up, AFDAS was detected in 33% of AC patients and in 14% of the remaining ones (p=0.003). However, AC was not independently associated with AFDAS, contrary to left atrial volume index (>34 mL/m<sup>2</sup>, OR 2.35 (CI 1.09 to 5.06) p=0029).</p><p><strong>Conclusion: </strong>AC as defined in ARCADIA is mostly based on NT pro BNP elevation (76% of patients) and is associated with age and inflammation. Moreover, AC was not independently associated with AFDAS at follow-up. The ARCADIA trial, which compares aspirin to apixaban in patients with embolic strokes of undetermined source with AC markers and must, therefore be analysed in the light of these limitations.</p><p><strong>Trial registration number: </strong>NCT03570060.</p>","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":" ","pages":"165-173"},"PeriodicalIF":4.4000,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11103154/pdf/","citationCount":"0","resultStr":"{\"title\":\"Distribution of atrial cardiomyopathy markers and association with atrial fibrillation detected after ischaemic stroke in the SAFAS study.\",\"authors\":\"Romain Didier, Lucie Garnier, Gauthier Duloquin, Alexandre Meloux, Audrey Sagnard, Mathilde Graber, Geoffrey Dogon, Karim Benali, Thibaut Pommier, Gabriel Laurent, Catherine Vergely, Yannick Bejot, Charles Guenancia\",\"doi\":\"10.1136/svn-2023-002447\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Atrial cardiomyopathy (AC) is an emerging concept explaining the pathophysiology of cardioembolic strokes in absence of atrial fibrillation (AF). A definition based on the presence of electrical abnormality (P-wave terminal force in lead V1 (PTFV1) >5000 µV×ms), N-Terminal pro-B-type natriuretic peptide (NT pro BNP) >250 pg/mL and/or indexed left atrial diameter (LADI) >3 cm/m² is currently tested in the ARCADIA (AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke) trial. We set out to estimate the prevalence of AC as defined in the ARCADIA trial, its determinants and its association with AF detected after stroke (AFDAS).</p><p><strong>Methods: </strong>Stepwise screening for silent Atrial Fibrillation After Stroke (SAFAS) study prospectively included 240 ischaemic stroke patients. AC markers were complete for 192 of them and 9 were not included in this analysis because AF had been diagnosed on admission.</p><p><strong>Results: </strong>A total of 183 patients were analysed, of whom 57% (104 patients) met the AC criteria (79 NT-proBNP, 47 PTFV1, 4 LADI). In the multivariate logistic regression, C reactive protein >3 mg/L (OR (95% CI) 2.60 (1.30 to 5.21), p=0.007) and age (OR (95% CI) 1.07 (1.04 to 1.10), p<0.001) were found to be independently associated with AC. After 6 months of follow-up, AFDAS was detected in 33% of AC patients and in 14% of the remaining ones (p=0.003). However, AC was not independently associated with AFDAS, contrary to left atrial volume index (>34 mL/m<sup>2</sup>, OR 2.35 (CI 1.09 to 5.06) p=0029).</p><p><strong>Conclusion: </strong>AC as defined in ARCADIA is mostly based on NT pro BNP elevation (76% of patients) and is associated with age and inflammation. Moreover, AC was not independently associated with AFDAS at follow-up. The ARCADIA trial, which compares aspirin to apixaban in patients with embolic strokes of undetermined source with AC markers and must, therefore be analysed in the light of these limitations.</p><p><strong>Trial registration number: </strong>NCT03570060.</p>\",\"PeriodicalId\":22021,\"journal\":{\"name\":\"Stroke and Vascular Neurology\",\"volume\":\" \",\"pages\":\"165-173\"},\"PeriodicalIF\":4.4000,\"publicationDate\":\"2024-04-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11103154/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Stroke and Vascular Neurology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/svn-2023-002447\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Stroke and Vascular Neurology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/svn-2023-002447","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：心房心肌病（AC）是一个新兴概念，可解释无心房颤动（AF）情况下心源性栓塞中风的病理生理学。目前，ARCADIA（AtRial Cardiopathy and Antithrombotic Drugs In Prevention After Cryptogenic stroke，心房心肌病和预防隐源性中风的抗血栓药物）试验正在测试一种基于存在电异常（V1导联P波终末力（PTFV1）>5000 µV×ms）、N-末端前B型钠尿肽（NT pro BNP）>250 pg/mL和/或指数左心房直径（LADI）>3 cm/m²的定义。我们的目的是估算 ARCADIA 试验中定义的心房颤动患病率、其决定因素及其与中风后检测到的房颤（AFDAS）的关联：方法：卒中后无声房颤逐步筛查（SAFAS）研究前瞻性地纳入了 240 名缺血性卒中患者。其中 192 人的心房颤动标记物完整，9 人因入院时已确诊心房颤动而未纳入分析：共分析了 183 名患者，其中 57% （104 名患者）符合 AC 标准（79 名 NT-proBNP、47 名 PTFV1、4 名 LADI）。在多变量逻辑回归中，C 反应蛋白 >3 mg/L (OR (95% CI) 2.60 (1.30 to 5.21), p=0.007) 和年龄 (OR (95% CI) 1.07 (1.04 to 1.10), p34 mL/m2, OR 2.35 (CI 1.09 to 5.06) p=0029)：ARCADIA中的AC定义主要基于NT pro BNP升高（76%的患者），并与年龄和炎症有关。此外，AC 与随访时的 AFDAS 无关。ARCADIA 试验比较了阿司匹林和阿哌沙班对具有 AC 标记的不明原因栓塞性中风患者的治疗效果，因此必须根据这些局限性进行分析：试验注册号：NCT03570060。
Distribution of atrial cardiomyopathy markers and association with atrial fibrillation detected after ischaemic stroke in the SAFAS study.
Background: Atrial cardiomyopathy (AC) is an emerging concept explaining the pathophysiology of cardioembolic strokes in absence of atrial fibrillation (AF). A definition based on the presence of electrical abnormality (P-wave terminal force in lead V1 (PTFV1) >5000 µV×ms), N-Terminal pro-B-type natriuretic peptide (NT pro BNP) >250 pg/mL and/or indexed left atrial diameter (LADI) >3 cm/m² is currently tested in the ARCADIA (AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke) trial. We set out to estimate the prevalence of AC as defined in the ARCADIA trial, its determinants and its association with AF detected after stroke (AFDAS).
Methods: Stepwise screening for silent Atrial Fibrillation After Stroke (SAFAS) study prospectively included 240 ischaemic stroke patients. AC markers were complete for 192 of them and 9 were not included in this analysis because AF had been diagnosed on admission.
Results: A total of 183 patients were analysed, of whom 57% (104 patients) met the AC criteria (79 NT-proBNP, 47 PTFV1, 4 LADI). In the multivariate logistic regression, C reactive protein >3 mg/L (OR (95% CI) 2.60 (1.30 to 5.21), p=0.007) and age (OR (95% CI) 1.07 (1.04 to 1.10), p<0.001) were found to be independently associated with AC. After 6 months of follow-up, AFDAS was detected in 33% of AC patients and in 14% of the remaining ones (p=0.003). However, AC was not independently associated with AFDAS, contrary to left atrial volume index (>34 mL/m2, OR 2.35 (CI 1.09 to 5.06) p=0029).
Conclusion: AC as defined in ARCADIA is mostly based on NT pro BNP elevation (76% of patients) and is associated with age and inflammation. Moreover, AC was not independently associated with AFDAS at follow-up. The ARCADIA trial, which compares aspirin to apixaban in patients with embolic strokes of undetermined source with AC markers and must, therefore be analysed in the light of these limitations.
期刊介绍：
Stroke and Vascular Neurology (SVN) is the official journal of the Chinese Stroke Association. Supported by a team of renowned Editors, and fully Open Access, the journal encourages debate on controversial techniques, issues on health policy and social medicine.
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