STAF评分预测复发性急性缺血性卒中患者的阵发性心房颤动

STAF score predict paroxysmal atrial fibrillation in patients with recurrent acute ischemic stroke

目的探讨STAF(Score for the Targeting of Atrial Fibrillation)评分对复发性急性缺血性卒中患者阵发性心房颤动(paroxysmal atrial fibrillation,PAF)的预测价值。方法回顾性纳入2014年1月至2020年1月期间在惠州市中心人民医院神经内科住院的连续复发性急性缺血性卒中患者。将所有患者分为窦性心律(sinus rhythm,SR)组和PAF组。PAF定义为在上次卒中住院期间或出院后未发现PAF,本次复发急性缺血性卒中后经常规心电图、动态心电图或长程心电监护发现PAF。应用多变量logistic回归分析评估复发急性缺血性卒中患者PAF的独立相关因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线评估STAF对复发急性缺血性卒中患者PAF的预测价值。结果共纳入234例复发性急性缺血性卒中患者,男性174例(74.4%),年龄(67.15±10.63)岁。SR组199例(85.0%),PAF组35例(15.0%)。单变量分析显示,PAF组年龄>62岁(94.3%对63.8%;χ^(2)=12.777,P<0.001)和左心房扩大(54.3%对11.1%;χ^(2)=40.379,P<0.001)的患者比例显著高于SR组。多变量logistic回归分析显示,年龄[优势比(odds ratio,OR)1.071,95%置信区间(confidence interval,CI)1.028~1.114;P=0.001]或年龄>62岁(OR 17.512,95%CI 2.881~106.453;P=0.002)、左心房扩大(OR 17.511,95%CI 6.298~48.687;P<0.001)、无血管病因(OR 8.562,95%CI 2.534~28.923;P=0.001)以及STAF评分(OR 2.715,95%CI 1.969~3.744;P<0.001)和STAF评分≥5分(OR 12.714,95%CI 5.636~28.681;P<0.001)与PAF独立相关。ROC曲线分析显示,STAF预测复发急性缺血性卒中患者PAF的曲线下面积为0.848(95%CI 0.779~0.917),STAF≥5分预测PAF的敏感性和特异性分别为58.1%和89.4%;预测复发性不明原因缺血性卒中患者PAF的曲线下面积为0.809(95%CI 0.663~0.956),STAF≥5分预测PAF的敏感性和特异性分别为53.8%和91.3%。结论年龄>62岁、左心房扩大以及无血管病因的复发性急性缺血性卒中患者很有可能存在PAF。STAF对复发性急性缺血性卒中患者合并PAF具有中等预测价值,但敏感性不高。

Objective To investigate the predictive value of STAF(score for the targeting of atrial fibrillation)score for paroxysmal atrial fibrillation(PAF)in patients with recurrent acute ischemic stroke.Methods Consecutive patients with recurrent acute ischemic stroke hospitalized in the Department of Neurology,Huizhou Municipal Central Hospital from January 2014 to January 2020 were enrolled retrospectively.All patients were divided into a sinus rhythm(SR)group and a PAF group.PAF was defined as no PAF during the last stroke hospitalization or after discharge,and PAF was found by routine ECG,ambulatory ECG or long-term ECG monitoring after this recurrent acute ischemic stroke.Multivariate logistic regression analysis was used to evaluate the independent related factors of PAF in patients with recurrent acute ischemic stroke.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of STAF for PAF in patients with recurrent acute ischemic stroke.Results A total of 234 patients with recurrent acute ischemic stroke were enrolled,including 174 males(74.4%),aged 67.15±10.63 years,and 199(85.0%)in the SR group and 35(15.0%)in the PAF group.Univariate analysis showed that the proportion of patients in age>62 years old(94.3%vs.63.8%;χ^(2)=12.777,P<0.001)and left atrial enlargement(54.3%vs.11.1%;χ^(2)=40.379,P<0.001)of the PAF group was significantly higher than those of the SR group.Multivariate logistic regression analysis showed that age(odd ratio[OR]1.071,95% confidence interval[CI]1.028-1.114;P=0.001)or age>62 years(OR 17.512,95%CI 2.881-106.453;P=0.002),left atrial enlargement(OR 17.511,95%CI 6.298-48.687;P<0.001),absence of vascular etiology(OR 8.562,95%CI 2.534-28.923;P=0.001),STAF score(OR 2.715,95%CI 1.969-3.744;P<0.001)and STAF score≥5(OR 12.714,95%CI 5.636-28.681;P<0.001)were independently associated with PAF.ROC curve analysis showed that the area under the curve of STAF for predicting PAF in patients with recurrent acute ischemic stroke was 0.848(95%CI 0.779-0.917),and the sensitivity and specificity of STAF≥5 for predicting PAF were 58.1% and 89.4%,respectively;the area under the curve for predicting PAF in patients with recurrent ischemic stroke of undetermined cause was 0.809(95%CI 0.663-0.956),and the sensitivity and specificity of STAF≥5 for predicting PAF were 53.8% and 91.3%,respectively.Conclusions PAF is likely to exist in patients with recurrent acute ischemic stroke and aged>62 years,left atrial enlargement and absence of vascular etiology.STAF has medium predictive value for PAF in patients with recurrent acute ischemic stroke,but the sensitivity is not high.