Tip 2 Diyabetik Hastalarda 24 Saatlik Ritim Monitörizasyonunda Paroksismal Atriyal Fibrilasyon Sıklığını Belirlemede CHA2DS2VASC Skorunun ve Diabetes Mellitusla İlgili Demografik ve Klinik Faktörlerin Rolü

Abstract

Amaç: Diabetes mellitus atriyal fibrilasyon ve tromboembolizm için risk faktörüdür. CHA2DS2VASC skoru atriyal fibrilasyonda tromboemboli riskini gösteren bir skorlama sistemidir. Atriyal fibrilasyon risk faktörlerini de içeren bir sınıflama sistemi olduğundan atriyal fibrilasyon riskinde artışı da gösteriyor olabilir. Bu çalışmada, tip 2 diyabetiklerde CHA2DS2VASC skorunun ve diyabetle ilgili faktörlerin 24 saatlik ritim monitörizasyonunda atriyal fibrilasyon sıklığını tespit etmedeki rolünü araştırdık. Gereç ve Yöntem: Ocak 2012 ve Ocak 2017 tarihleri arasında Başkent Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı’nda 24 saat ritim monitörizasyonu yapılan >18 yaş tip 2 diyabeti olan erişkin hastalar geriye dönük dahil edildiler. CHA2DS2VASC skoru ve demografik veriler, klinik parametreler, transtorasik ekokardiyografiler kaydedildi. Paroksismal atriyal fibrilasyon ve çalışma parametreleri arasındaki ilişki korelasyon analizleri ile araştırıldı. Atriyal fibrilasyon ile bağımsız ilişkili parametreler çok değişkenli analiz ile test edildi. Anlamlı parametreler için alıcı işletim karakteristiği (ROC) eğrileri çizdirilerek en uygun kesim değerleri bulundu. Bulgular: Toplam 378 hastanın 65’inde (%17,2) paroksismal atriyal fibrilasyon vardı. Atriyal fibrilasyon olan grupta CHA2DS2VASC skoru anlamlı şekilde yüksekti. Paroksismal atriyal fibrilasyonlu hastalar anlamlı şekilde daha yaşlı, daha uzun süredir diyabetli, daha geniş sol atriyal çapa sahiptiler. Tek değişkenli analizlerde atriyal fibrilasyon ile ilişkili parametreler yaş, diyabet süresi, CHA2DS2VASC skoru ve sol atriyal çaptı. CHA2DS2VASC skoru çok değişkenli analizde 24 saatlik ritim monitörizasyonunda paroksismal atriyal fibrilasyonun bağımsız prediktörüydü. CHA2DS2VASC skoru ≥3 olan hastalarda daha düşük skora sahip hastalara göre atriyal fibrilasyon hızı anlamlı şekilde daha fazlaydı. Sonuç: Tip 2 diyabetik hastalarda CHA2DS2VASC skoru 24 saatlik ritim monitörizasyonunda atriyal fibrilasyonun anlamlı prediktörüdür. Yüksek CHA2DS2VASC skoru olan tip 2 diyabetiklerde atriyal fibrilasyon varlığı akla getirilmelidir. Bu konuda randomize kontrollü araştırmalara gereksinim vardır

Keywords

• Atriyal Fibrilasyon
• Diabetes Mellitus
• 24 Saat Ritim Monitörizasyonu
• CHA2DS2VASC Skoru

The Role of CHA2DS2VASC Score and Diabetes-Related Demographic and Clinical Factors for Determining the İncidence of Paroxysmal Atriyal Fibrillation in 24 Hour Rhythm Monitoring in Patients with Type 2 Diabetes Mellitus

Abstract

Objectives: Diabetes mellitus is a risk factor for atrial fibrillation and thromboembolism. CHA2DS2VASC score is a scoring system indicating risk of thromboembolism in atrial fibrillation. As it also includes risk factors for atrial fibrillation, it may also indicate a heightened atrial fibrillation risk. Herein, we investigated the role of CHA2DS2VASC score and diabetes-related factors for determining paroxysmal atrial fibrilallation incidence in 24-hour rhythm monitorization among type 2 diabetic patients. Materials and Methods: We retrospectively analyzed type 2 diabetic patients older than 18 years of age who underwent 24-hour rhythm monitoring at Başkent University, Faculty of Medicine, Department of Cardiology between January 2012 and January 2017. The patients’ CHA2DS2VASC scores, clinical and demographic parameters, and transthoracic echocardiography findings were recorded. The correlations between paroxysmal atrial fibrillation and study parameters was analyzed. Multivariate analysis was used to determine significant independent predictors of atrial fibrillation. ROC analysis were done to determine the best cut-off points for significant predictors of atrial fibrillation. Results: A total of 65 (17.2%) of 378 patients had atrial fibrillation in 24-hour rhythm monitoring. The patients with atrial fibrillation had a significantly greater CHA2DS2VASC score. The patients with atrial fibrillation were significantly older, had a longer diabetes duration, and a larger left atrium. Age, diabetes duration, CHA2DS2VASC score, and left atrial diameter were significantly correlated with atrial fibrillation while CHA2DS2VASC score was a significant independent predictor of paroxysmal atrial fibrillation in 24-hour rhythm monitoring. The patients with a CHA2DS2VASC score of equal to or greater than 3 had a significantly greater incidence of paroxysmal atrial fibrillation. Conclusion: Among type 2 diabetics, CHA2DS2VASC score is a significant predictor of atrial fibrillation in 24-hour rhythm monitoring. Atrial fibrillation should be suspected in type 2 diabetics with a high CHA2DS2VASC score. Randomized controlled studies are needed in this field

Keywords

• Atrial Fibrillation
• Diabetes Mellitus
• 24 Hour Rhythm Monitorization
• CHA2DS2VASC Score

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