Cheuk-Lik Wong, Ho-Kee Vicki Tam, Chun-Kit Vincent Fok, Pong-Kai Ellen Lam, Lai-Ming Fung
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Spontaneous sinus conversion occurred in 89 (66.9%) patients in which 85 (94%) patients developed sinus conversion before or within 6 months after having achieved euthyroidism. The remaining 44 (33.1%) had persistent AF. The rate of ischemic stroke was numerically higher among patients who had persistent AF than those with spontaneous sinus conversion (15.9% versus 10.1%; log-rank 0.442, <i>p</i> = 0.506). Patients who sustained an ischemic stroke were older (71 ± 11 years versus 62 ± 16 years, <i>p</i> = 0.023) and had a trend towards higher CHA<sub>2</sub>DS<sub>2</sub>-VASc score (2.9 ± 1.7 versus 2.3 ± 1.7, <i>p</i> = 0.153). History of smoking (adjusted odds ratio 4.9, 95% CI [1.8,14.0], <i>p</i> = 0.002), a larger left atrial diameter (adjusted odd ratio 2.6, 95% CI [1.2,5.5], <i>p</i> = 0.014), and a relatively lower free thyroxine level at diagnosis (adjusted odd ratio 2.1, 95% CI [1.2,3.5], <i>p</i> = 0.008) were associated with persistence of AF on multivariate analysis.</p><p><strong>Conclusion: </strong>Persistence of thyrotoxic AF occurred in one-third of patients and spontaneous sinus conversion was unlikely after six months of euthyroidism. High rate of ischemic stroke was observed among patients with persistent thyrotoxic AF and older age. Patients with factors associated with persistent AF, especially older people, should be closely monitored beyond 6 months so that anticoagulation can be initiated in a timely manner to reduce risk of ischemic stroke.</p>","PeriodicalId":17394,"journal":{"name":"Journal of Thyroid Research","volume":null,"pages":null},"PeriodicalIF":1.7000,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2017/4259183","citationCount":"11","resultStr":"{\"title\":\"Thyrotoxic Atrial Fibrillation: Factors Associated with Persistence and Risk of Ischemic Stroke.\",\"authors\":\"Cheuk-Lik Wong, Ho-Kee Vicki Tam, Chun-Kit Vincent Fok, Pong-Kai Ellen Lam, Lai-Ming Fung\",\"doi\":\"10.1155/2017/4259183\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Atrial fibrillation (AF) is one of the commonest cardiovascular manifestations of thyrotoxicosis. A significant proportion of patients have persistent AF which may have long term consequences, for example, ischemic stroke.</p><p><strong>Methods: </strong>We performed a retrospective cohort study in a regional hospital from January 2004 to June 2016 to examine the clinical characteristics and outcomes of thyrotoxic patients who presented with atrial fibrillation and to investigate possible factors associated with persistent atrial fibrillation and ischemic stoke.</p><p><strong>Results: </strong>Among 1918 patients who had a diagnosis of thyrotoxicosis, 133 (6.9%) patients presented with AF. Spontaneous sinus conversion occurred in 89 (66.9%) patients in which 85 (94%) patients developed sinus conversion before or within 6 months after having achieved euthyroidism. The remaining 44 (33.1%) had persistent AF. The rate of ischemic stroke was numerically higher among patients who had persistent AF than those with spontaneous sinus conversion (15.9% versus 10.1%; log-rank 0.442, <i>p</i> = 0.506). Patients who sustained an ischemic stroke were older (71 ± 11 years versus 62 ± 16 years, <i>p</i> = 0.023) and had a trend towards higher CHA<sub>2</sub>DS<sub>2</sub>-VASc score (2.9 ± 1.7 versus 2.3 ± 1.7, <i>p</i> = 0.153). History of smoking (adjusted odds ratio 4.9, 95% CI [1.8,14.0], <i>p</i> = 0.002), a larger left atrial diameter (adjusted odd ratio 2.6, 95% CI [1.2,5.5], <i>p</i> = 0.014), and a relatively lower free thyroxine level at diagnosis (adjusted odd ratio 2.1, 95% CI [1.2,3.5], <i>p</i> = 0.008) were associated with persistence of AF on multivariate analysis.</p><p><strong>Conclusion: </strong>Persistence of thyrotoxic AF occurred in one-third of patients and spontaneous sinus conversion was unlikely after six months of euthyroidism. High rate of ischemic stroke was observed among patients with persistent thyrotoxic AF and older age. Patients with factors associated with persistent AF, especially older people, should be closely monitored beyond 6 months so that anticoagulation can be initiated in a timely manner to reduce risk of ischemic stroke.</p>\",\"PeriodicalId\":17394,\"journal\":{\"name\":\"Journal of Thyroid Research\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2017-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1155/2017/4259183\",\"citationCount\":\"11\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Thyroid Research\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1155/2017/4259183\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2017/12/12 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q4\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Thyroid Research","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1155/2017/4259183","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2017/12/12 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
引用次数: 11
摘要
背景:心房颤动(AF)是甲状腺毒症最常见的心血管表现之一。相当比例的患者有持续性房颤，这可能有长期后果，例如缺血性中风。方法:2004年1月至2016年6月在某地区医院进行回顾性队列研究，分析甲状腺毒性心房颤动患者的临床特征和预后，探讨持续性心房颤动和缺血性卒中的可能相关因素。结果:在诊断为甲状腺毒症的1918例患者中，133例(6.9%)出现房颤。89例(66.9%)患者发生自发性窦性转换，其中85例(94%)患者在实现甲状腺功能正常之前或后6个月内发生窦性转换。其余44例(33.1%)患有持续性房颤。持续性房颤患者的缺血性卒中发生率高于自发性窦性房颤患者(15.9% vs 10.1%;Log-rank 0.442, p = 0.506)。缺血性脑卒中患者年龄较大(71±11岁比62±16岁，p = 0.023)， CHA2DS2-VASc评分有较高的趋势(2.9±1.7比2.3±1.7,p = 0.153)。多因素分析显示，吸烟史(校正优势比4.9,95% CI [1.8,14.0]， p = 0.002)、左房内径较大(校正奇比2.6,95% CI [1.2,5.5]， p = 0.014)、诊断时游离甲状腺素水平相对较低(校正奇比2.1,95% CI [1.2,3.5]， p = 0.008)与房颤持续存在相关。结论:三分之一的患者持续存在甲状腺毒性房颤，在甲状腺功能亢进6个月后不太可能发生自发性窦性转换。顽固性甲状腺毒性房颤患者及老年房颤患者缺血性卒中发生率较高。伴有持续性房颤相关因素的患者，尤其是老年人，6个月以上应密切监测，及时启动抗凝治疗，降低缺血性卒中风险。
Thyrotoxic Atrial Fibrillation: Factors Associated with Persistence and Risk of Ischemic Stroke.
Background: Atrial fibrillation (AF) is one of the commonest cardiovascular manifestations of thyrotoxicosis. A significant proportion of patients have persistent AF which may have long term consequences, for example, ischemic stroke.
Methods: We performed a retrospective cohort study in a regional hospital from January 2004 to June 2016 to examine the clinical characteristics and outcomes of thyrotoxic patients who presented with atrial fibrillation and to investigate possible factors associated with persistent atrial fibrillation and ischemic stoke.
Results: Among 1918 patients who had a diagnosis of thyrotoxicosis, 133 (6.9%) patients presented with AF. Spontaneous sinus conversion occurred in 89 (66.9%) patients in which 85 (94%) patients developed sinus conversion before or within 6 months after having achieved euthyroidism. The remaining 44 (33.1%) had persistent AF. The rate of ischemic stroke was numerically higher among patients who had persistent AF than those with spontaneous sinus conversion (15.9% versus 10.1%; log-rank 0.442, p = 0.506). Patients who sustained an ischemic stroke were older (71 ± 11 years versus 62 ± 16 years, p = 0.023) and had a trend towards higher CHA2DS2-VASc score (2.9 ± 1.7 versus 2.3 ± 1.7, p = 0.153). History of smoking (adjusted odds ratio 4.9, 95% CI [1.8,14.0], p = 0.002), a larger left atrial diameter (adjusted odd ratio 2.6, 95% CI [1.2,5.5], p = 0.014), and a relatively lower free thyroxine level at diagnosis (adjusted odd ratio 2.1, 95% CI [1.2,3.5], p = 0.008) were associated with persistence of AF on multivariate analysis.
Conclusion: Persistence of thyrotoxic AF occurred in one-third of patients and spontaneous sinus conversion was unlikely after six months of euthyroidism. High rate of ischemic stroke was observed among patients with persistent thyrotoxic AF and older age. Patients with factors associated with persistent AF, especially older people, should be closely monitored beyond 6 months so that anticoagulation can be initiated in a timely manner to reduce risk of ischemic stroke.
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