Electrocardiographic and echographic predictive factors of silent AF in ESUS stroke - 12/05/23
, A. Achour 2, Emna Jarrar 3, Sami Ouennes 2, Imen Ben Ali 2, Mehdi Slim 2, Rym Gribaa 2, Elies Neffati 2, Sana Ben Amor 3Riassunto |
Introduction |
Stroke is a major public health problem, the leading cause of acquired disability in adults and the third leading cause of death worldwide. Ischaemic stroke accounts for 80% of all strokes. Approximately 20% of DVAs are associated with atrial fibrillation (AF). However, 25% remain of undetermined origin (ESUS) with a risk of recurrence under anti-platelet therapy greater than 4% per year. In this population, the challenge is the detection of subclinical atrial fibrillation (AF), the incidence of which could reach 25%. The effectiveness of the probabilistic anticoagulation strategy has not been demonstrated in this population, making it necessary to identify ESUS patients at high risk of subclinical AF.
Objective |
The aim of this study is to determine the incidence and the electrocardiographic and echographic predictive factors of silent AF in ESUS stroke.
Method |
Monocentric descriptive and analytical historical cohort study conducted at the Neurology Department between January 2016 and December 2020. Three hundred Esus patients were included.
Results |
In our study, 42/300 (14%) patients had at least one episode of AF (>30s). In univariate analysis, the variables significantly associated with sluggish AF in ESUS-type stroke were age greater than or equal to 60years (P=0.004, OR=3.76), female gender (P=0.045, OR=1.94), P-wave markers (abnormal axis, prolonged duration), P-wave dispersion (P<10−3), a high number of supraventricular extrasystoles (P<10−3, OR=1.007), OG dilatation (P<10−3, OR=1.61) and diastolic dysfunction (P<10−3, OR=30.25).
In multivariate analysis, p-wave dispersion (P<10−3, OR=57.77), number of SVSEs>500/24h (P<10−3, OR=185.83), and left atrial area>20cm2 (P<10−3, OR=74.7) appeared to be independent predictors of the occurrence of a subclinical AF episode.
Conclusion |
In this cohort of ESUS patients, several factors appeared to be predictive of subclinical AF. This result is consistent with the finding of several studies that the subgroup of ESUS patients with these factors appeared to benefit from probabilistic anticoagulation in preventing cerebral infarct recurrence.
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Vol 15 - N° 2
P. 201 - maggio 2023 Ritorno al numero
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