| Abstract | Cilj istraživanja: Cilj istraživanja bio je utvrditi učestalost i način dijagnostike fibrilacije atrija u bolesnika s ishemijskim moždanim udarom te usporediti klinička obilježja i ishode bolesnika s i bez fibrilacije atrija.
Ispitanici i metode: Retrospektivna studija za koju su iz povijesti bolesti prikupljeni podatci o bolesnicima s dijagnozom ishemijskog moždanog udara u KBC-u Split u 2019. godini. Podatci su uključivali dob, spol, anamnezu fibrilacije atrija i antikoagulantne terapije, MSCT nalaz i anamnestičke podatke o već preboljelom ishemijskom moždanom udaru, nalaz 12-kanalnog EKG-a i 24h EKG po Holteru te podatke o komorbiditetima - hipertenziji, dijabetesu, zatajenju srca i kardiovaskularnim bolestima.
Rezultati: Od 887 ispitanika s dijagnozom ishemijskog moždanog udara, fibrilaciju atrija imalo je njih 346 (39%). Čak 73% bolesnika s već poznatom fibrilacijom atrija nije uopće uzimalo antikoagulacijsku terapiju ili je nije uzimalo redovito. Novootkrivena fibrilacija atrija dijagnosticirana je u 174 bolesnika. Standardnim 12-kanalnim EKG-om detektirano je 87% novootkrivenih fibrilacija atrija, 24h EKG-om po Holteru 12,5%, a srčanim elektrostimulatorom 0,5%. Postoji statistički značajna povezanost smrtnog ishoda s fibrilacijom atrija ( χ2 =50, p<0,001).Dokazana je i statistički značajna povezanost pojavnosti fibrilacije atrija i vrijednosti CHA2DS2-VASc scorea (z=9,1; p<0,001) te povezanost CHA2DS2-VASc scorea sa smrtnim ishodom (z=6,4, p<0,001) i ponovljenim ishemijskim moždanim udarom (z=2,7; p=0,008), neovisno o fibrilaciji atrija.
Zaključak: Čak 39% bolesnika s ishemijskim moždanim udarom imalo je fibrilaciju atrija, a 50,3% bolesnika otkriveno je tek nakon ishemijskog incidenta. Samo 27% pacijenata s poznatom fibrilacijom bilo je adekvatno antikoagulirano. Bolesnici s fibrilacijom imaju lošije ishode nakon moždanog udara te postoji potreba za češćim screeningom bolesnika, posebice onih s višim CHA2DS2-VASc scoreom. 24h EKG po Holteru nije osjetljiva metoda za detekciju fibrilacije atrija i nema ga potrebe snimati nakon dokaza fibrilacije na 12-kanalnom EKG zapisu. |
| Abstract (english) | Aim of the study: The aim of the study was to determine the frequency and method of diagnosis of atrial fibrillation in patients with ischemic stroke and to compare the clinical features and outcomes of patients with and without atrial fibrillation.
Subjects and methods: A retrospective study for which data on patients diagnosed with ischemic stroke at the University Hospital of Split in 2019 was collected from the medical history. Data included age, sex, history of atrial fibrillation and anticoagulant therapy, MSCT finding and anamnestic data on previous ischemic stroke, 12-lead ECG and 24 h Holter ECG findings, and data on comorbidities - hypertension, diabetes, heart failure and CVDs.
Results: Of 887 patients diagnosed with ischemic stroke, 346 (39%) had atrial fibrillation. As many as 73% of patients with pre-existing atrial fibrillation were not taking anticoagulation therapy at all or were not taking it regularly. Newly detected atrial fibrillation was diagnosed in 174 patients. A standard 12-lead ECG detected 87% of newly detected atrial fibrillation, a 24-hour Holter ECG detected 12.5% and a pacemaker detected 0,5%.There was a statistically significant association of mortality with atrial fibrillation (χ2 = 50, p <0.001). There was also a statistically significant association between the incidence of atrial fibrillation and CHA2DS2-VASc score (z = 9.1; p <0.001) as well as between CHA2DS2-VASc score and death (z = 6.4, p <0.001) and recurrent ischemic stroke. (z = 2.7; p = 0.008), independent of atrial fibrillation.
Conclusions: As many as 39% of patients with ischemic stroke had atrial fibrillation, and 50,3% of patients were detected only after an ischemic event. Only 27% of patients with known fibrillation were adequately anticoagulated. Patients with fibrillation have worse outcomes after stroke and there is a need for more frequent screening of patients, especially those with a higher CHA2DS2-VASc score. A 24h Holter ECG is not a sensitive method for detecting atrial fibrillation and there is no need to record it after evidence of fibrillation on a 12-lead ECG. |
