Asymptomatic embolization in subjects with atrial fibrillation not taking anticoagulants: a prospective study.
Asymptomatic embolization in subjects with atrial fibrillation not taking anticoagulants: a prospective study.
复制标题
未服用抗凝剂的房颤受试者的无症状栓塞：一项前瞻性研究。
DOI：
10.1161/01.str.29.9.1810
复制
发表时间：
1998
期刊：
影响因子：
8.3
通讯作者：
Hugh S. Markus
中科院分区：
文献类型：
--
作者：
M. Cullinane;Ray Wainwright;Angie Brown;Mark Monaghan;Hugh S. Markus
背景和目的
栓塞症被认为是非瓣膜性心房颤动(NVAF)患者卒中的主要原因。检测NVAF患者的无症状栓子信号(ES)可能有助于识别中风高危患者和监测个别受试者的治疗。我们测定了未服用华法林的NVAF患者中无症状ES的发生率。
方法
对111例连续服用阿司匹林或不接受抗血栓或抗凝治疗的NVAF患者进行双侧大脑中动脉1h经颅多普勒记录。86例患者均能进行充分的记录。在79名受试者中，第二次进行了录音，以研究时间的变异性。30名年龄匹配的对照组受试者也进行了一小时的录音。
结果
NVAF患者中有13例(15.1%)检出ES，而对照组未检出ES(P=0.02)。ES在有症状的NVAF(4/30，13.1%)和无症状的NVAF(9/56，16.1%)中均可检出(P=0.04，与对照组相比，P=0.02)。ES的出现与吸烟、糖尿病、高血压、阿司匹林的使用、阿司匹林剂量、症状状态、左房大小、左心功能或经胸超声心动图检测到的左房血栓的存在无关。重复记录使ES患者增至21例(26.6%)。考虑到两种记录的结果，ES的出现与吸烟状况、糖尿病、高血压、阿司匹林的使用、阿司匹林剂量、年龄、症状状态、左房大小或左心功能之间再次没有关联。在重复记录时，在有症状组中只有2名患者(8%)状态改变，而在无症状组中有15名患者(29%)。
结论
在NVAF患者中可检测到低频ES。特别是在无症状患者中，ES表现出明显的时间变异性。我们发现，先前报道的中风风险增加的临床和超声心动图标志物的存在与ES的存在之间没有相关性。在决定这种技术在NVAF患者中的临床应用之前，这种相关性需要进一步的研究。
BACKGROUND AND PURPOSE
Embolism is believed to be the major cause of stroke in patients with nonvalvular atrial fibrillation (NVAF). The detection of asymptomatic embolic signals (ES) in individuals with NVAF might allow identification of patients at high risk of stroke and monitoring of therapy in individual subjects. We determined the frequency of asymptomatic ES in patients with NVAF who were not taking warfarin.
METHODS
Bilateral transcranial Doppler recordings were made for 1 hour from the middle cerebral arteries of 111 successive patients with NVAF taking aspirin alone or no antithrombotic or anticoagulant therapy. Adequate recordings could be made in 86 patients. In 79 subjects, recordings were performed on a second occasion to study temporal variability. Recordings for a single hour were also made in 30 age-matched control subjects.
RESULTS
ES were detected in 13 (15.1%) of NVAF subjects but in no control subjects (P=0.02). ES were detected both in subjects with symptomatic NVAF (4 of 30 [13.1%], P=0.04 versus controls) and asymptomatic NVAF (9 of 56 [16.1%], P=0.02 versus controls). There was no correlation between the presence of ES and smoking status, diabetes, hypertension, aspirin use, aspirin dose, symptomatic status, left atrial size, left ventricular function, or the presence of left atrial thrombus detected on transthoracic echocardiography. Repeating the recording increased the number of patients with ES to 21 (26.6%). On considering the results of both recordings, again there was no association for either recording between the presence of ES and smoking status, diabetes, hypertension, aspirin use, aspirin dose, age, symptomatic status, left atrial size, or left ventricular function. On repeating the recording, in the symptomatic group only 2 patients (8%) changed status, in contrast to 15 (29%) in the asymptomatic group.
CONCLUSIONS
ES can be detected in patients with NVAF at a low frequency. Particularly in asymptomatic patients, ES show marked temporal variability. We found no correlation between the presence of previously reported clinical and echocardiographic markers of increased stroke risk and the presence of ES. This association requires further investigation before the clinical utility of this technique in patients with NVAF is decided.
影响因子：
8.3
作者：
WOLF, PA;ABBOTT, RD;KANNEL, WB
通讯作者：
KANNEL, WB