Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases
Atrial cardiopathy and the prognosis of ischemic stroke
First author：Yueyang Wu,Xiaomeng Yang
Corresponding author：Yongjun Wang
essential_information
- Person in charge：Yueyang Wu,Xiaomeng Yang
- Data Sources： CNSR-Ⅲ
- Number of papers：CNSR-Ⅲ20190939
- Published time：2023-03-08
2023-03-08
Published articles
Journal：Eur Stroke J
Publication type: Original Contributions
IF(IF): 5.894
PMID: 37021197 Link To Pubmed Full text Download
Background And Purpose
心房基质异常本身可能独立于房颤导致缺血性卒中，是部分栓塞性卒中患者潜在的血栓栓塞来源。既往研究已发现阵发性室上性心动过速、频发房早、V1导联P波终末电势等心房性心肌病的标记物与缺血性卒中风险升高相关，尤其是在ESUS患者中心房性心肌病标记物的发生率显著高于其他类型的卒中。那么心房性心肌病标志物作为心房基质异常的预警信号，其对于缺血性卒中/ESUS患者的预后有何影响？合并心房性心肌病标记物的缺血性卒中/ESUS患者是否伴随更多的卒中复发、心血管事件、系统性栓塞事件？
Method
Based on the Third China National Stroke Registry, we evaluated different atrial cardiopathy markers including increased P-wave terminal force in V1 (PTFV1), advanced interatrial block (aIAB), prolonged P-wave duration, prolonged P-wave dispersion, paroxysmal supraventricular tachycardia, premature atrial contractions, prolonged PR interval, and severe left atrial enlargement in ischemic stroke patients. The outcomes were death and ischemic stroke recurrence at 1 year. The association between atrial cardiopathy markers and outcomes was analyzed using Cox regression models.
Conclusion
Atrial cardiopathy markers, especially PTFV1 and aIAB, are significantly associated with a higher risk of poor prognosis in patients with ischemic stroke.
Main results
At 1-year follow-up, 486 (3.4%) patients had died and 1317 (9.3%) patients had experienced ischemic stroke recurrence. After adjustment for clinical risk factors including atrial fibrillation, PTFV1 > 5000 μV·ms (adjusted hazard ratio [HR] 1.70, 95% confidence interval [CI]: 1.18-2.45, p = 0.004) and aIAB (adjusted HR 1.47, 95% CI: 1.14-1.91, p = 0.003) were significantly associated with mortality. PTFV1 > 5000 μV·ms was significantly associated with ischemic stroke recurrence (adjusted HR 1.54, 95% CI: 1.22-1.96, p = 0.0004). This association was observed although we excluded patients diagnosed with atrial fibrillation.