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Akut iskemik inmeli hastalarda atriyal fibrilasyonu öngörmek için atria skoru

Year 2019, Volume 41, Issue 1, 142 - 149, 28.03.2019
https://doi.org/10.7197/223.vi.521114

Abstract

Amaç: Atrial fibrilasyon ile iskemik inme yakından ilişkili olup iskemik inme geçiren hastalarda atriyal fibrilasyon ataklarının normal popülasyona oranla daha fazla olduğu gösterilmiştir. İskemik inme geçiren hastalarda atriyal fibrilasyonu ön gördürücü etkenler birçok çalışmada araştırılmıştır. Bu çalışmanın amacı da iskemik inme hastalarındaki ATRİA skorlama sisteminin atriyal fibrilasyonla ilişkisini ortaya koyabilmektir.

Yöntem: Çalışmaya sinüs ritminde serebrovasküler olay geçiren 104 hasta dahil edildi. Hastalar hastanede yatış esnasında uygulanan 24 saatlik holter EKG takiplerinde atriyal fibrilasyon atağı olanlar ve olmayanlar olarak iki gruba ayrıldı. Tüm hastaların ATRİA skorları hesaplandı.

Bulgular: ATRİA skor ortalaması atriyal fibrilasyon tespit edilen grupta anlamlı oranda yüksek bulundu.  (p = 0.001) ATRİA skorunun atriyal fibrilasyonu predikte ettiği cut-off değeri   %83.3 sensitivite ve %78.4 spesifite ile 5 bulundu (AUC=0,866; %95 CI, 0.786-0.924, p<0.001). ATRİA skoru ve komponentleri tek değişkenli analizde önemli prognostik öneme sahipti. Çok değişkenli regresyon analizinde, ATRİA skoru ve ejeksiyon fraksiyonun (OR=1.360, 95% CI: 1.090-1.697, p=0.006 ;OR =0.900, 95% CI: 0.834-0.971, p =0.007 sırası ile ) atriyal fibrilasyon atağı ile ilişkili olduğu görüldü.

Sonuç: Sinüs ritminde serebrovasküler olay geçiren hastalarda atriyal fibrilasyon gelişmesi ile ATRİA skoru arasında bağımsız bir ilişki vardır. 

References

  • 1.Adams HP Jr, Bendixen BH, Kappelle LJ, et al. 3rd. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993 ;24(1):35-41.
  • 2.Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22(8):983-8.
  • 3.Yetim E, Topcuoglu MA, Canpolat U, et al. Nonsustained Atrial Fibrillation in Ischemic Stroke Patients and Stroke-Free Controls From the Perspective of Stroke Pathophysiology. J Am Heart Assoc. 2016 ; 30;5(10). pii: e004021
  • 4.Singer DE, Chang Y, Borowsky LH, et al. A new risk scheme to predict ischemic stroke and other thromboembolism in atrial fibrillation: the ATRIA study stroke risk score. J Am Heart Assoc. 2013 ;2(3):e000250.
  • 5.Van Den Ham HA, Klungel OH, Singer DE, et al. Comparative performance of ATRIA, CHADS2, and CHA2DS2-VASc risk scores predicting stroke in patients with atrial fibrillation in a national primary care database and the impact on treatment decisions. J Am Coll Cardiol 2015;66:1851-9
  • 6.Ziegler PD, Glotzer TV, Daoud EG, et al. Incidence of newly detected atrial arrhythmias via implantable devices in patients with a history of thromboembolic events. Stroke 2010;41(2):256–60.
  • 7.Favilla CG, Ingala E, Jara J,et al . Predictors of finding occult atrial fibrillation after cryptogenic stroke. Stroke 2015;46 (5):1210–5.
  • 8.Scheitz JF, Erdur H, Haeusler KG, et al. Insular cortex lesions, cardiac troponin, and detection of previously unknown atrial fibrillation in acute ischemic stroke: insights from the troponin elevation in acute ischemic stroke study. Stroke 2015;46(5):1196–201.
  • 9.Liu R, Yang X, Li S, et al. Modified CHADS(2) and CHA(2)DS(2)-VASc scores to predict atrial fibrillation in acute ischemic stroke patients. J Clin Neurosci. 2018 May;51:35-38.
  • 10. Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: A report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J. Am. Soc. Echocardiogr. 2005;18:1440-63
  • 11.Miyasaka Y, Barnes ME, Gersh BJ, et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation 2006;114(2):119–25.
  • 12.Gbadebo TD, Okafor H, Darbar D. Differential impact of race and risk factors on incidence of atrial fibrillation. Am Heart J 2011;162(1):31–7.
  • 13.Aksnes TA, Schmieder RE, Kjeldsen SE, et al.Impact of new-onset diabetes mellitus on development of atrial fibrillation and heart failure in high-risk hypertension (from the VALUE Trial). Am J Cardiol 2008;101 (5):634–8.
  • 14.Zuo ML, Liu S, Chan KH, et al. The CHADS2 and CHA 2DS 2-VASc scores predict new occurrence of atrial fibrillation and ischemic stroke. J Interv Card Electrophysiol 2013;37(1):47–54.
  • 15.Engdahl J, Andersson L, Mirskaya M, et al. Stepwise screening of atrial fibrillation in a 75-year-old population: implications for stroke prevention. Circulation 2013;127(8):930–7.
  • 16. Kirchhof P, Benussi S, Kotecha D,et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016;18(11):1609-78.

Atria score to predict atrial fibrillation in acute ischemic stroke patients

Year 2019, Volume 41, Issue 1, 142 - 149, 28.03.2019
https://doi.org/10.7197/223.vi.521114

Abstract

Objective: Atrial fibrillation is closely associated with ischemic stroke. Ischemic stroke has been shown to be more frequent in patients with atrial fibrillation than the normal population. The predictive factors of atrial fibrillation in patients with ischemic stroke have been investigated in several studies. The aim of this study is to reveal the relationship with atrial fibrillation and ATRIA score in ischemic stroke patients.  

Method: 104 patients who suffered a cerebrovascular event in sinus rhythm were included in the study. Patients were divided into two groups as detected or undetected diagnosed atrial fibrillation in 24-hour Holter ECG monitoring applied during hospitalization. The ATRIA risk score was calculated for all patients.

Results: Average of ATRIA score was found to be significantly higher in the group with detected atrial fibrillation (P = 0.001). The optimal cut-off value for ATRIA score to predict atrial fibrillation was >5 with a specificity of 78.4% and a sensitivity of 83.3% (area under the curve 0.866; 95% confidence interval (CI), 0.786–0.924, p<0.001). The ATRIA score and its components had important significance in the univariate analysis. ATRIA score and ejection fraction (OR=1.360, 95% CI: 1.090-1.697, p=0.006; OR =0.900, 95% CI: 0.834-0.971, p =0.007 respectively) were observed to be associated with atrial fibrillation in the multivariate regression analysis.   

Conclusions: There is an independent relationship between the ATRIA score and the development of atrial fibrillation, in patients with ischemic stroke in sinus rhythm.

References

  • 1.Adams HP Jr, Bendixen BH, Kappelle LJ, et al. 3rd. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993 ;24(1):35-41.
  • 2.Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22(8):983-8.
  • 3.Yetim E, Topcuoglu MA, Canpolat U, et al. Nonsustained Atrial Fibrillation in Ischemic Stroke Patients and Stroke-Free Controls From the Perspective of Stroke Pathophysiology. J Am Heart Assoc. 2016 ; 30;5(10). pii: e004021
  • 4.Singer DE, Chang Y, Borowsky LH, et al. A new risk scheme to predict ischemic stroke and other thromboembolism in atrial fibrillation: the ATRIA study stroke risk score. J Am Heart Assoc. 2013 ;2(3):e000250.
  • 5.Van Den Ham HA, Klungel OH, Singer DE, et al. Comparative performance of ATRIA, CHADS2, and CHA2DS2-VASc risk scores predicting stroke in patients with atrial fibrillation in a national primary care database and the impact on treatment decisions. J Am Coll Cardiol 2015;66:1851-9
  • 6.Ziegler PD, Glotzer TV, Daoud EG, et al. Incidence of newly detected atrial arrhythmias via implantable devices in patients with a history of thromboembolic events. Stroke 2010;41(2):256–60.
  • 7.Favilla CG, Ingala E, Jara J,et al . Predictors of finding occult atrial fibrillation after cryptogenic stroke. Stroke 2015;46 (5):1210–5.
  • 8.Scheitz JF, Erdur H, Haeusler KG, et al. Insular cortex lesions, cardiac troponin, and detection of previously unknown atrial fibrillation in acute ischemic stroke: insights from the troponin elevation in acute ischemic stroke study. Stroke 2015;46(5):1196–201.
  • 9.Liu R, Yang X, Li S, et al. Modified CHADS(2) and CHA(2)DS(2)-VASc scores to predict atrial fibrillation in acute ischemic stroke patients. J Clin Neurosci. 2018 May;51:35-38.
  • 10. Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: A report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J. Am. Soc. Echocardiogr. 2005;18:1440-63
  • 11.Miyasaka Y, Barnes ME, Gersh BJ, et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation 2006;114(2):119–25.
  • 12.Gbadebo TD, Okafor H, Darbar D. Differential impact of race and risk factors on incidence of atrial fibrillation. Am Heart J 2011;162(1):31–7.
  • 13.Aksnes TA, Schmieder RE, Kjeldsen SE, et al.Impact of new-onset diabetes mellitus on development of atrial fibrillation and heart failure in high-risk hypertension (from the VALUE Trial). Am J Cardiol 2008;101 (5):634–8.
  • 14.Zuo ML, Liu S, Chan KH, et al. The CHADS2 and CHA 2DS 2-VASc scores predict new occurrence of atrial fibrillation and ischemic stroke. J Interv Card Electrophysiol 2013;37(1):47–54.
  • 15.Engdahl J, Andersson L, Mirskaya M, et al. Stepwise screening of atrial fibrillation in a 75-year-old population: implications for stroke prevention. Circulation 2013;127(8):930–7.
  • 16. Kirchhof P, Benussi S, Kotecha D,et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016;18(11):1609-78.

Details

Primary Language English
Subjects Health Care Sciences and Services
Published Date March 2019
Journal Section Medical Science Research Articles
Authors

Hakan GÜNEŞ (Primary Author)
KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNİVERSİTESİ, TIP FAKÜLTESİ
0000-0003-3853-5046
Türkiye

Publication Date March 28, 2019
Published in Issue Year 2019, Volume 41, Issue 1

Cite

APA Güneş, H. (2019). Atria score to predict atrial fibrillation in acute ischemic stroke patients . Cumhuriyet Medical Journal , 41 (1) , 142-149 . DOI: 10.7197/223.vi.521114