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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Newly diagnosed atrial fibrillation after acute ischemic stroke and transient ischemic attack: Importance of immediate and prolonged continuous cardiac monitoring
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Newly diagnosed atrial fibrillation after acute ischemic stroke and transient ischemic attack: Importance of immediate and prolonged continuous cardiac monitoring

机译：急性缺血性中风和短暂性脑缺血发作后新诊断的心房颤动：立即和长期连续心脏监护的重要性

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摘要

Atrial fibrillation (AF) is the major cause of cardioembolic stroke. It often remains occult when asymptomatic and paroxysmal. We hypothesized that the detection of AF after acute ischemic stroke (AIS) or transient ischemic attack (TIA) could be improved by using continuous cardiac monitoring (CCM) immediately after admission. We sought to determine the detection rate of AF by immediate in-hospital CCM after cryptogenic and noncryptogenic AIS or TIA in patients without a previous diagnosis of AF. We retrospectively studied a cohort of 155 patients with cryptogenic and noncryptogenic AIS or TIA without known AF. We compared the detection rates of newly diagnosed AF (NDAF) in patients admitted to areas with CCM and those never admitted to these areas. We developed a multiple logistic regression model for identifying predictors of NDAF. We characterized NDAF episodes and analyzed how the availability of CCM data changed secondary prevention strategies. We detected NDAF in 21 patients (13.5%). Diagnostic rates of NDAF in patients who underwent CCM and those who did not undergo CCM were 18.2% and 2.2%, respectively (P =.005). The median time from admission to recognition of NDAF was 2.0 days. Most NDAFs were paroxysmal (95.2%) and lasted less than 1 hour (85.7%). Diabetes mellitus and infarct size were predictors of NDAF. Detection of NDAF prompted the initiation of anticoagulation therapy in 8.2% of the patients admitted to areas with CCM availability. Our findings suggest that immediate and prolonged CCM significantly improves the detection of NDAF after cryptogenic and noncryptogenic AIS or TIA, and that diabetes mellitus and infarct size are significantly associated with NDAF.
机译：心房颤动（AF）是心脏栓塞性中风的主要原因。无症状和阵发性时常保持隐匿性。我们假设入院后立即使用连续心脏监测（CCM）可以改善急性缺血性中风（AIS）或短暂性脑缺血发作（TIA）后房颤的检测。我们试图确定未经先天性AF诊断的患者在隐源性和非隐源性AIS或TIA治疗后立即通过院内CCM检测AF的比率。我们回顾性研究了155例无已知房颤的隐源性和非隐源性AIS或TIA患者。我们比较了接受CCM区域的患者和从未进入这些区域的患者的新诊断AF（NDAF）的检出率。我们开发了用于确定NDAF预测因子的多元逻辑回归模型。我们对NDAF事件进行了表征，并分析了CCM数据的可用性如何改变了二级预防策略。我们在21例患者中检出了NDAF（13.5％）。接受CCM和未接受CCM的患者NDAF的诊断率分别为18.2％和2.2％（P = .005）。从入院到识别NDAF的中位时间为2.0天。大部分NDAF为阵发性（95.2％），持续时间少于1小时（85.7％）。糖尿病和梗死面积是NDAF的预测指标。检测到NDAF促使入院CCM的患者中有8.2％的患者开始抗凝治疗。我们的发现表明，立即和长期CCM可以显着改善隐源性和非隐源性AIS或TIA后NDAF的检测，并且糖尿病和梗塞面积与NDAF显着相关。

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