Περίληψη:
Background: Occult paroxysmal atrial fibrillation (PAF) is a common and potential treatable cause of cryptogenic stroke (CS). We sought to prospectively identify independent predictors of atrial fibrillation (AF) detection in patients with CS and sinus rhythm on baseline electrocardiogram (ECG), without prior AF history. We had hypothesized that cardiac arrhythmia detection during neurosonology examinations (Carotid Duplex (CDU) and Transcranial Doppler (TCD)) may be associated with higher likelihood of AF detection. Methods: Consecutive CS patients were prospectively evaluated over a six-year period. Demographics, clinical and imaging characteristics of cerebral ischemia were documented. The presence of arrhythmia during spectral waveform analysis of CDU/TCD was recorded. Left atrial enlargement was documented during echocardiography using standard definitions. The outcome event of interest included PAF detection on outpatient 24-h Holter ECG recordings. Statistical analyses were performed using univariate and multivariate logistic regression models. Results: A total of 373 patients with CS were evaluated (mean age 60 ± 11 years, 67% men, median NIHSS-score 4 points). The rate of PAF detection of any duration on Holter ECG recordings was 11% (95% CI 8%–14%). The following three variables were independently associated with the likelihood of AF detection on 24-h Holter-ECG recordings in both multivariate analyses adjusting for potential confounders: age (OR per 10-year increase: 1.68; 95% CI: 1.19–2.37; p = 0.003), moderate or severe left atrial enlargement (OR: 4.81; 95% CI: 1.77–13.03; p = 0.002) and arrhythmia detection during neurosonology evaluations (OR: 3.09; 95% CI: 1.47–6.48; p = 0.003). Conclusion: Our findings underline the potential utility of neurosonology in improving the detection rate of PAF in patients with CS. © 2019 by the authors. Licensee MDPI, Basel, Switzerland.
Συγγραφείς:
Liantinioti, C.
Palaiodimou, L.
Tympas, K.
Parissis, J.
Theodorou, A.
Ikonomidis, I.
Chondrogianni, M.
Zompola, C.
Triantafyllou, S.
Roussopoulou, A.
Kargiotis, O.
Serdari, A.
Bonakis, A.
Vadikolias, K.
Voumvourakis, K.
Stefanis, L.
Filippatos, G.
Tsivgoulis, G.
Λέξεις-κλειδιά:
cholesterol; glucose, adult; Article; biochemical analysis; brain ischemia; cerebrovascular accident; cervical spine radiography; computer assisted tomography; demography; echocardiography; echography; electrocardiogram; female; heart arrhythmia; heart rhythm; Holter monitoring; human; major clinical study; male; neuroimaging; nuclear magnetic resonance imaging; outpatient; paroxysmal atrial fibrillation; predictive value; sinus rhythm; transcranial Doppler ultrasonography
