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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Embolic Stroke of Undetermined Source and Detection of Atrial Fibrillation on Follow-Up: How Much Causality Is There?
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Embolic Stroke of Undetermined Source and Detection of Atrial Fibrillation on Follow-Up: How Much Causality Is There?

机译：不确定来源的栓塞性卒中和房颤的随访检测：有多少因果关系？

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Background: There is increasing debate whether atrial fibrillation (AF) episodes during follow-up in patients with embolic stroke of undetermined source (ESUS) are causally associated with the event. AF-related strokes are more severe than strokes of other etiologies. In this context, we aimed to compare stroke severity between ESUS patients diagnosed with AF during follow-up and those who were not. We hypothesized that, if AF episodes detected during follow-up are indeed causally associated with the index event, stroke severity in the AF group should be higher than the non-AF group. Methods: Dataset was derived from the Athens Stroke Registry. ESUS was defined by the Cryptogenic Stroke/ESUS International-Working-Group criteria. Stroke severity was assessed by the National Institutes of Health Stroke Scale (NIHSS) score. Cumulative probabilities of recurrent stroke or peripheral embolism in the AF and non-AF ESUS groups were estimated by Kaplan-Meier analyses. Results: Among 275 ESUS patients, AF was detected during follow-up in 80 (29.1%), either during repeated electrocardiogram monitoring (18.2%) or during hospitalization for stroke recurrence (10.9%). NIHSS score was similar between the two groups (5 [2-13] versus 5 [2-14], P = .998). More recurrent strokes or peripheral embolisms occurred in the AF group compared with the non-AF group (42.5% versus 13.3%, P = .001). Conclusions: Stroke severity is similar between ESUS patients who were diagnosed with AF during follow-up and those who were not. Given that AF-related strokes are more severe than strokes of other etiologies, this finding challenges the assumption that the association between ESUS and AF detected during follow-up is as frequently causal as regarded.
机译：背景：不确定来源的栓塞性卒中（ESUS）患者在随访过程中房颤（AF）发作是否与该事件有因果关系，这一争论越来越多。与AF相关的中风比其他病因的中风更为严重。在这种情况下，我们旨在比较在随访期间被诊断为房颤的ESUS患者与未进行房颤的ESUS患者之间的卒中严重程度。我们假设，如果在随访期间发现的房颤发作确实与指数事件有因果关系，则房颤组的卒中严重程度应高于非房颤组。方法：数据集来自雅典中风登记处。 ESUS是由Cryptogenic Stroke / ESUS International-Working-Group标准定义的。中风严重程度通过美国国立卫生研究院中风量表（NIHSS）评分进行评估。通过Kaplan-Meier分析评估了AF和非AF ESUS组中复发性中风或周围性栓塞的累积概率。结果：在275例ESUS患者中，有80例（29.1％）在随访期间检测到房颤，无论是在重复心电图监测（18.2％）还是住院期间卒中复发（10.9％）。两组的NIHSS评分相似（5 [2-13]对5 [2-14]，P = .998）。与非AF组相比，AF组发生更多的中风或周围性栓塞（42.5％比13.3％，P = .001）。结论：随访期间被诊断患有房颤的ESUS患者与未进行房颤的卒中严重程度相似。鉴于与AF相关的中风比其他病因的中风更为严重，因此这一发现对以下假设提出了质疑，即在随访期间发现的ESUS与AF之间的关联与因果关系一样频繁。

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