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Stroke:随机试验中门诊心脏监护的心房颤动发现率小于预期

来源:丁香园 2012-12-15 21:11

观察性研究提示:门诊心脏监护发现:5%-20%的新发卒中患者存在之前没有发现的心房颤动。对此,美国Weill Cornell医学院神经学与神经科学系的Hooman Kamel博士等人进行了一项研究,研究结果在线发表在2012年11月27日的Stroke杂志上。研究结果显示:随机试验中心房颤动的发现率小于预期,机会性心律失常常见,监护的依从性欠佳。

该研究是一项随机的试验性研究。研究人员将40位隐源性缺血性卒中或高危短暂性缺血发作的患者随机分配入佩带Cardioner移动心脏门诊远程测量检测仪21天组,或单纯接受常规随访组。在进行全面检查后,研究人员排除了有房颤记录的患者和有其他明显卒中病因的患者。研究人员在发病后3个月和1年联系患者的医师,了解是否有心房颤动的诊断或有卒中或短暂性脑缺血发作的复发。

研究结果显示:研究队列的基线特性匹配之前那些在卒中后进行监护的观察性研究。在监护组,患者在64%的分配时间里穿戴监护器,有25%的患者不依从监测。两个研究端都没有患者被诊断为心房颤动。心脏监测发现了0个心房颤动患者 (0%; 95% 可信区间:0%–17%), 2位患者出现了短阵性心动过速(10%; 95% 可信区间:1%–32%),2位患者出现了阵发性室性心动过速(10%; 95% 可信区间:1%–32%)。

该研究显示:在关于隐源性卒中后心脏监测的第一个有报道的随机试验中,心房颤动的发现率小于预期,机会性心律失常常见,监护的依从性欠佳。研究的结果清楚地指出:前瞻性确定存在阵发性心房颤动风险的卒中患者是件很困难的事情,而且心脏监护要有足够的依从性。(生物谷Bioon.com)

Pilot Randomized Trial of Outpatient Cardiac Monitoring After Cryptogenic Stroke

Hooman Kamel, MD, Babak B. Navi, MD, Lucas Elijovich, MD, S. Andrew Josephson, MD, Alan H. Yee, DO, Gordon Fung, MD, S. Claiborne Johnston, MD, PhD and Wade S. Smith, MD, PhD

Background and Purpose—Observational studies indicate that outpatient cardiac monitoring detects previously undiagnosed atrial fibrillation (AF) in 5% to 20% of patients with recent stroke. However, it remains unknown whether the yield of monitoring exceeds that of routine clinical follow-up. Methods—In a pilot trial, we randomly assigned 40 patients with cryptogenic ischemic stroke or high-risk transient ischemic attack to wear a Cardionet mobile cardiac outpatient telemetry monitor for 21 days or to receive routine follow-up alone. After thorough investigation, we excluded patients with documented AF or other apparent stroke pathogenesis. We contacted patients and their physicians at 3 months and at 1 year to ascertain any diagnoses of AF or recurrent stroke or transient ischemic attack. Results—The baseline characteristics of our cohort broadly matched those of previous observational studies of monitoring after stroke. In the monitoring group, patients wore monitors for 64% of the assigned days, and 25% of patients were not compliant at all with monitoring. No patient in either study arm received a diagnosis of AF. Cardiac monitoring revealed AF in zero patients (0%; 95% confidence interval, 0%–17%), brief episodes of atrial tachycardia in 2 patients (10%; 95% confidence interval, 1%–32%), and nonsustained ventricular tachycardia in 2 patients (10%; 95% confidence interval, 1%–32%). Conclusions—In the first reported randomized trial of cardiac monitoring after cryptogenic stroke, the rate of AF detection was lower than expected, incidental arrhythmias were frequent, and compliance with monitoring was suboptimal. Our findings highlight the challenges of prospectively identifying stroke patients at risk for harboring paroxysmal AF and ensuring adequate compliance with cardiac monitoring.

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