Predictors of ischemic stroke in non-rheumatic atrial fibrillation.
We retrospectively analyzed the clinical features of patients with non-rheumatic atrial fibrillation to identify risk factors of ischemic stroke. Non-rheumatic atrial fibrillation is associated with an increased risk of ischemic stroke. However, the predictors of ischemic stroke in non-rheumatic atrial fibrillation are unclear. The study population consisted of 122 patients with non-rheumatic atrial fibrillation who had no previous clinical cerebral strokes at the start of the follow-up. Patients with cardiomyopathy and paroxysmal or intermittent atrial fibrillation were excluded from the study. The mean age was 61.7 +/- 12.8 years. We defined two endpoints; namely, occurrence of ischemic stroke (endpoint 1), and ischemic stroke or cardiac death (endpoint 2). During the follow-up, 18 patients had ischemic stroke and 6 patients experienced cardiac death. The 5-year event-free rates for endpoints 1 and 2 were 87.4% and 85.0%, respectively. A Cox analysis revealed that endpoint 1 was significantly associated with age (risk ratio (RR) = 1.106, P = 0.0052), end-diastolic left ventricular dimension (RR = 0.882, P = 0.0393), end-systolic left ventricular dimension (RR = 1.149, P = 0.0323) and the thickness of the interventricular septum (RR = 1.493, P = 0.0111). Endpoint 2 was associated with age (RR = 1.122, P = 0.0004), left atrial dimension (RR = 1.057, P = 0.0666), end-diastolic left ventricular dimension (RR = 0.935, P = 0.0426), fractional shortening (RR = 0.880, P = 0.0001) and the thickness of the left ventricular posterior wall (RR = 1.644, P = 0.0004). The present results suggest that, in addition to left ventricular dimensions and left atrial dimension, left ventricular hypertrophy may be associated with ischemic stroke.
First Department of Internal Medicine, Shiga University of Medical Science, Japan.
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Yoshida
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Nakamura
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Higashikawa
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Kinoshita
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D002545:Brain Ischemia / Q000453:epidemiology / Q000209:etiology*; D003643:Death; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013927:Thrombosis / Q000150:complications* / Q000453:epidemiology