心房过早复杂负担作为阵发性心房颤动和栓塞性脑卒中的风险分层预测因子。

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-06-06 DOI:10.1016/j.jstrokecerebrovasdis.2025.108369

Jin Un Kim , Alice Snell , Peter Kabunga , Md Shajedur Rahman Shawon , Saeedur Rahman

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引用次数: 0

摘要

研究隐源性脑卒中的病因是具有挑战性的。隐蔽性阵发性心房颤动（pAF）可能是一个重要的因素，但经常被标准的24小时心脏监测遗漏。心房早衰复合体（APC）是心房肌病的标志和房颤的预测因子。我们采用14天动态心脏监测作为一种新的监测模式来评估APC负担与房颤之间的关系。在没有pAF检测的情况下，APC负担可能是栓塞性卒中患者危险分层的有用替代标志物。方法：我们回顾性收集了2022年4月至2023年10月期间确诊或疑似中风或短暂性脑缺血发作（TIA）的成人（≥18岁）的数据，这些患者使用Zio XT®（irhyth Technologies， UK）进行了为期14天的心脏监测。排除100%心房颤动（AF）负担的患者。结果：共454例患者，其中男性268例，占59%；中位年龄：67岁[IQR: 56-76])。29例确诊为pAF。在调整分析中，APC运行bbb20与pAF的几率增加270%相关(OR: 3.70, 95% CI: 1.47-9.36， p110显示最强关联（OR: 7.71, 95% CI: 2.49-23.86, p=0.04）。高APC负荷与放射学上出现的栓塞性卒中有很强的相关性，并且与APC跑量的增加有越来越强的相关性[APC跑量bbbb20与栓塞性卒中的几率增加265%相关（OR: 3.65, 95% CI: 2.06-6.46）， p讨论：APC跑量的存在和负荷与栓塞性卒中密切相关。高APC负担与pAF患者表现出相似的卒中病因学表现。这似乎与APC负担低的患者不同，后者大多数患者具有其他已确定的病因。这可能是由于心房肌病的下游后果。在没有pAF的情况下，APC的鉴定可能对隐源性脑卒中患者的诊断和治疗具有重要意义。

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Atrial premature complex burden as a risk stratification predictor of paroxysmal atrial fibrillation and embolic stroke

Introduction

Investigating the aetiology of cryptogenic stroke is challenging. Occult paroxysmal atrial fibrillation (pAF) is likely a significant contributor, but is often missed by standard 24 h cardiac monitoring. Atrial premature complexes (APC) are markers of atrial myopathy and predictors of AF. We employ 14-day ambulatory cardiac monitoring as a novel monitoring modality to assess the association between APC burden and pAF. In the absence of pAF detection, APC burden may be a useful surrogate marker for risk stratification in patients with embolic stroke.

Methods

We retrospectively collected data from April 2022 to October 2023 on adults (≥18 years) with confirmed or suspected stroke or transient ischemic attack (TIA) who underwent 14-day cardiac monitoring using Zio XT® (iRhythm Technologies, UK). Patients with 100 % atrial fibrillation (AF) burden were excluded.

Results

A total of 454 patients (male: 268, 59 %; median age: 67 years [IQR: 56–76]) were included. 29 were diagnosed with pAF. In adjusted analysis, APC runs >20 was associated with a 270 % increase in the odds of pAF (OR: 3.70, 95 % CI: 1.47–9.36, p < 0.01), with APC runs >110 showing the strongest association (OR: 7.71, 95 % CI: 2.49–23.86, p = 0.04). High APC burden showed a strong correlation with radiologically embolic appearing strokes with increasing strength of association with higher APC run counts [APC runs >20 was associated with 265 % increased odds of embolic stroke (OR: 3.65, 95 % CI: 2.06-6.46, p < 0.01)]. Age and hypertension were significant predictors of pAF, while obesity and smoking were not significant.

Discussion

The presence and burden of APC run are strongly associated with embolic strokes. High APC burden displays similar aetiological stroke presentation to those with pAF. This appears to be distinct from those with low APC burden, where the majority had alternative identified aetiology. This is likely due to downstream consequences of atrial myopathy. In the absence of pAF, APC identification may be important in the diagnostic and therapeutic considerations of cryptogenic stroke patients.

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.