高血压和肾功能异常与接受抗凝治疗的 1 型评价心脏瓣膜、风湿性或人工瓣膜性房颤患者发生缺血性中风的风险

R. Winanti, S. Raharjo, R. Ariani, D. Hanafy, C. A. Atmadikoesoemah, P. Almazini, Armalya Pritazahra, Y. Yuniadi
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摘要

背景:房颤会大大增加中风风险。最广泛使用的房颤风险预测评分是 CHA2DS2-VASC。以往的研究主要集中在其对非瓣膜性房颤患者的疗效上。少数研究考虑了瓣膜性房颤患者,但强调该工具的评分准确性较差。研究目的本研究旨在评估与抗凝评估心脏瓣膜、风湿性或人工(ERA)1 型瓣膜性房颤患者缺血性卒中发生率相关的临床因素和超声心动图参数。方法:我们利用印度尼西亚心房颤动登记处(OneAF)的数据进行了一项回顾性队列研究。研究纳入了 2015 年 1 月至 2019 年 12 月期间登记在册的 EHRA 1 型瓣膜性房颤患者。研究结果在329名患有二尖瓣狭窄或机械人工瓣膜的房颤患者中,缺血性中风的发生率为17例(5.2%)。多变量分析显示,高血压(OR 5.59;95% CI [1.93-16.15];P=0.001)和估计肾小球滤过率(eGFR)≤59 ml/min/m2(OR 3.62;95% CI [1.30-10.02];P=0.013)这两个临床因素与缺血性卒中的发生率独立相关。在该人群中,没有超声心动图参数与缺血性卒中的发生率相关。结论高血压和肾功能受损会增加患者缺血性脑卒中的风险。有必要开展进一步研究,以确定预测该亚组缺血性中风的适当评分系统。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Hypertension and Abnormal Renal Function and the Risk of Ischaemic Stroke in Anticoagulated Type 1 Evaluated Heart Valves, Rheumatic or Artificial Valvular AF
Background: AF substantially increases the risk of stroke. The most widely used risk prediction score for AF is CHA2DS2-VASC. Previous studies have mainly focused on its efficacy among patients with non-valvular AF. The few studies that have considered patients with valvular AF highlight the tool’s poor scoring accuracy. Objective: This study was conducted to evaluate the clinical factors and echocardiographic parameters related to the incidence of ischaemic stroke in anticoagulated evaluated heart valves, rheumatic or artificial (EHRA) type 1 valvular AF patients. Methods: We conducted a retrospective cohort study using data from the Indonesian Registry on Atrial Fibrillation (OneAF). Patients with EHRA type 1 valvular AF recorded in the registry from January 2015 to December 2019 were included in the study. Results: The incidence of ischaemic stroke was 17 (5.2%) out of 329 AF patients with mitral stenosis or mechanical prosthetic valves. A multivariate analysis showed that two clinical factors: hypertension (OR 5.59; 95% CI [1.93–16.15]; p=0.001) and estimated glomerular filtration rate (eGFR) ≤59 ml/min/m2 (OR 3.62; 95% CI [1.30–10.02]; p=0.013), were independently associated with the incidence of ischaemic stroke. No echocardiographic parameters were associated with the incidence of ischaemic stroke in this population. Conclusion: Hypertension and impaired renal function elevated the risk of ischaemic stroke in the patient population. Further research is necessary to determine the proper scoring system for predicting ischaemic stroke in this subgroup.
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