Atrial fibrillation(AF) is the most common arrhythmia in clinical practice. Several conventional and novel predictors of AF development and progression(from paroxysmal to persistent and permanent types) have been repo...Atrial fibrillation(AF) is the most common arrhythmia in clinical practice. Several conventional and novel predictors of AF development and progression(from paroxysmal to persistent and permanent types) have been reported. The most important predictor of AF progression is possibly the arrhythmia itself. The electrical, mechanical and structural remodeling determines the perpetuation of AF and the progression from paroxysmal to persistent and permanent forms. Common clinical scores such as the hypertension, age ≥ 75 years, transient ischemic attack or stroke, chronic obstructive pulmonary disease, and heart failure and the congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years, sex category scores as well as biomarkers related to inflammation may also add important information on this topic. There is now increasing evidence that even in patients with so-called lone or idiopathic AF, the arrhythmia is the manifestation of a structural atrial disease which has recently been defined and described as fibrotic atrial cardiomyopathy. Fibrosis results from a broad range of factors related to AF inducing pathologies such as cell stretch, neurohumoral activation, and oxidative stress. The extent of fibrosis as detected either by late gadolinium enhancement-magnetic resonance imaging or electroanatomic voltage mapping may guide the therapeutic approach based on the arrhythmia substrate. The knowledge of these risk factors may not only delay arrhythmia progression, but also reduce the arrhythmia burden in patients with first detected AF. The present review highlights on the conventional and novel risk factors of development and progression of AF.展开更多
文摘Atrial fibrillation(AF) is the most common arrhythmia in clinical practice. Several conventional and novel predictors of AF development and progression(from paroxysmal to persistent and permanent types) have been reported. The most important predictor of AF progression is possibly the arrhythmia itself. The electrical, mechanical and structural remodeling determines the perpetuation of AF and the progression from paroxysmal to persistent and permanent forms. Common clinical scores such as the hypertension, age ≥ 75 years, transient ischemic attack or stroke, chronic obstructive pulmonary disease, and heart failure and the congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years, sex category scores as well as biomarkers related to inflammation may also add important information on this topic. There is now increasing evidence that even in patients with so-called lone or idiopathic AF, the arrhythmia is the manifestation of a structural atrial disease which has recently been defined and described as fibrotic atrial cardiomyopathy. Fibrosis results from a broad range of factors related to AF inducing pathologies such as cell stretch, neurohumoral activation, and oxidative stress. The extent of fibrosis as detected either by late gadolinium enhancement-magnetic resonance imaging or electroanatomic voltage mapping may guide the therapeutic approach based on the arrhythmia substrate. The knowledge of these risk factors may not only delay arrhythmia progression, but also reduce the arrhythmia burden in patients with first detected AF. The present review highlights on the conventional and novel risk factors of development and progression of AF.
文摘目的探讨大动脉狭窄与大脑中动脉供血区梗死患者早期神经功能恶化（early neurological deterioration，END）的相关性。方法回顾性收集大脑中动脉供血区脑梗死患者，END定义为人院72h内美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分较基线值增加〉12分。利用颅脑血管成像对大脑中动脉和颈内动脉进行评价，狭窄程度分为无或轻度（〈50％）、中度（50％～70％）、重度（71％～99％）和闭塞（100％）。比较END组与非END组的临床危险因素、神经功能缺损程度、病灶大小以及主干动脉病变情况。结果共纳入256例大脑中动脉供血区梗死患者，其中70例（27．34％）患者发生END。END阳性组年龄（P=0．045）、梗死体积（P=0．045）、基线NIHSS评分（P=0．007）以及主干动脉狭窄程度（P=0．038）均显著高于或大于END阴性组。多变量logistic回归分析显示，基线NIHSS评分较高[优势比（odds ratio，OR）1．071，95％可信区间（confidence interval，CI）1．004～1．142；P=0．037]、梗死灶直径〉20mm（OR2．077，95％CI1．077～3．736；P=0．028）以及主干动脉重度狭窄（OR2．521，95％CI1．079～5．886；P=0．033）或闭塞（OR3．074，95％CI1．262～7．489；P=0．013）是END的独立预测因素。结论主干动脉重度狭窄或闭塞病变可能是急性大脑中动脉供血区梗死患者发生END的独立预测因素。
文摘目的探讨急性缺血性卒中患者静脉溶栓后早期神经功能恶化(early neurological deterioration,END)的预测因素及其对短期转归的影响。方法回顾性纳入2017年1月至2019年4月在徐州医科大学第二附属医院接受静脉溶栓治疗的急性缺血性卒中患者。END定义为入院7 d内美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分较基线时增加≥2分。出院时应用改良Rankin量表评价短期转归,0~2分定义为转归良好,3~6分定义为转归不良。运用多变量logistic回归分析确定END的独立预测因素及其与短期转归的相关性。结果共纳入199例接受静脉溶栓治疗的急性缺血性卒中患者。中位年龄68岁(四分位数间距:62~76岁),女性69例(34.7%),基线中位NIHSS评分6分(四分位数间距:3~12分)。35例(17.6%)患者发生END,症状进展主要发生在入院后2 d内(31例,88.6%),大多数END病因为缺血进展或再发(28例,80.0%)。单变量分析显示空腹血糖、有症状颅内出血与END相关(P均<0.05),但多变量logistic回归分析并未发现END的独立预测因素。排除12例短期转归资料缺失的患者,共187例纳入短期转归分析。其中,转归良好组110例,转归不良组77例。单变量分析显示,缺血性心脏病、心房颤动、轻度卒中、病因学分型、基线NIHSS评分、淋巴细胞计数、空腹血糖、中性粒细胞/淋巴细胞比值、血管内治疗以及END与短期转归相关(P均<0.05)。多变量logistic回归分析提示,高基线NIHSS评分(优势比1.350,95%可信区间1.182~1.541;P<0.001)和END(优势比32.540,95%可信区间6.149~172.21;P<0.001)为短期转归不良的独立危险因素。结论急性缺血性卒中静脉溶栓治疗后仍有部分患者发生END,而且END是患者短期转归不良的独立危险因素。
文摘目的探讨急性缺血性卒中患者早期神经功能恶化（early neurologic deterioration，END）的危险因素。方法回顾性纳入急性缺血性卒中患者，收集患者的临床资料和实验室检查结果。根据发病后7d内美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分变化分为END组与非END组，END定义为NIHSS评分较基线水平增加≥3分。采用多变量logistic回归分析确定急性缺血性卒中患者END的独立危险因素。结果共纳入328例急性缺血性卒中患者，其中74例（22．6％）发生END，254例（77．4％）未发生END。END组男性、高血压、既往卒中或短暂性脑缺血发作史、脑干或小脑梗死、人院前使用抗高血压药的患者构成比以及人院前收缩压均显著高于非END组（P均〈0．05），白细胞计数、中性粒细胞百分比、低密度脂蛋白胆固醇、空腹血糖、高半胱氨酸、C反应蛋白和纤维蛋白原水平均显著高于非END组（P均〈0．05）。多变量logistic回归分析显示，白细胞计数[优势比（oddsratio，OR）2．126，95％可信区间（confidence interval，CI）1．240～4．325）；P=0．028]、低密度脂蛋白胆固醇（OR2．486，95％CI 1．932～6．021；P=0．036）、高半胱氨酸（OR2．787，95％CI1．194～6．902；P=0．036）和C反应蛋白（OR3．416，95％CI1．552～10．650；P=0．032）较高是急性缺血性卒中患者发生END的独立预测因素。结论白细胞计数、低密度脂蛋白胆固醇、高半胱氨酸和C反应蛋白较高是急性缺血性卒中患者END的独立预测因素。
