Excessive Atrial Ectopy and Short Atrial Runs Increase the Risk of Stroke Beyond Incident Atrial Fibrillation
Excessive Atrial Ectopy and Short Atrial Runs Increase the Risk of Stroke Beyond Incident Atrial Fibrillation
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DOI：
10.1016/j.jacc.2015.05.018
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发表时间：
2015-07-21
影响因子：
24
通讯作者：
Sajadieh, Ahmad
中科院分区：
文献类型：
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作者：
Larsen, Bjorn Stroier;Kumarathurai, Preman;Sajadieh, Ahmad
背景：大约30%的缺血性卒中的病因不明。心房异位征(AE)的增加增加了房颤(AF)的风险，但AE增加的患者发生卒中的风险尚不清楚。目的本研究旨在研究增加的AE和短的房室运行是否会增加发生房颤以外的卒中风险。方法收集了哥本哈根Holter研究队列中678名年龄在55岁至75岁之间、没有心血管疾病、中风或房颤早期病史的男性和女性15年的随访数据。研究对象接受了48小时动态心电图、空腹血液检测和临床检查。过度的室上性异位活动(ESVEA)定义为每天房性早搏(PAC)=30次/小时或任何一次房性早搏(PAC；)=20次。在调整了基线风险因素后，当审查受试者发生房颤时(危险比[HR]：1.96；95%可信区间[CI]：1.10至3.49)或将房颤建模为时变暴露时(HR：2.00；95%可信区间：1.16至3.45)，ESVEA与缺血性中风相关。在发生中风的ESVEA受试者中，14.3%的人在中风前诊断为房颤。在ESVEA和CHA(2)DS(2)-VASc(充血性心力衰竭、高血压、75岁或以上、糖尿病、既往中风或短暂性脑缺血发作、血管疾病、年龄65~74岁、女性)评分=2的受试者中，卒中的发生率为每年2.4%，与观察到的房颤风险相当。在日常分析中，ESVEA是一个一致的发现。结论在中老年人群中，ESVEA与超过明显房颤的缺血性卒中风险增加相关。在这些研究对象中，中风更多地是第一临床表现，而不是房颤。(C)2015年，由美国心脏病学会基金会提供。
BACKGROUND Approximately 30% of ischemic strokes have an unknown cause. Increased atrial ectopy (AE) increases the risk of atrial fibrillation (AF), but the risk of stroke in patients with increased AE is unknown.OBJECTIVES This study aimed to examine whether increased AE and short atrial runs increase the risk of stroke beyond incident AF.METHODS Data were collected during a 15-year follow-up of the Copenhagen Holter Study cohort with 678 men and women between 55 and 75 years of age, with no earlier history of cardiovascular disease, stroke, or AF. Study subjects underwent 48-h ambulatory electrocardiography, fasting blood tests, and clinical examination. Excessive supraventricular ectopic activity (ESVEA) was defined as the presence of either >= 30 premature atrial contractions (PACs)/hour daily or any runs of >= 20 PACs.RESULTS Ninety-nine subjects (15%) demonstrated ESVEA. After adjusting for baseline risk factors, ESVEA was associated with ischemic stroke when censoring subjects at time of AF (hazard ratio [HR]: 1.96; 95% confidence interval [CI]: 1.10 to 3.49) or when modeling AF as a time-varying exposure (HR: 2.00; 95% CI: 1.16 to 3.45). Among subjects with ESVEA who developed a stroke, 14.3% had diagnosed AF before their stroke. The incidence of stroke in subjects with ESVEA and a CHA(2)DS(2)-VASc (congestive heart failure, hypertension, age 75 years or older, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, age 65 to 74 years, female) score of >= 2 was 2.4% per year, comparable to the risk observed in AF. In day-to-day analysis, ESVEA was a consistent finding.CONCLUSIONS ESVEA was associated with an increased risk of ischemic stroke beyond manifest AF in this middleaged and older population. Stroke was more often the first clinical presentation, rather than AF, in these study subjects. (C) 2015 by the American College of Cardiology Foundation.