Akut iskemik inmeli hastalarda paroksismal atriyal fibrilasyonu öngörmede TAPSE/PASP oranının yeri

Abstract

Amaç: Atriyal fibrilasyon (AF), kardiyoembolik inmenin en yaygın nedeni olmaya devam etmektedir. AF’nin bir alt tipi olan Paroksismal AF (PAF)’nin tespiti çoğu zaman zor olmakta ve bazen ilk olarak embolik inme sırasında saptanmaktadır. Tricuspid Annular Plane Systolic Excursion (TAPSE) ve ortalama pulmoner arter sistolik basıncı (PASP) rutinde kullanılan Transtorasik Ekokardiyografide (EKO) kolaylıkla tespit edilebilmektedir. Bu iki değerin oranı birçok kardiyak hastalıkta prognostik öneme sahip olduğu gösterilmiştir. Ancak bu oran ile PAF gelişmesi arasında ilişkiyi gösteren literatür bilgisinin olmaması bizim çalışmamızın ana hedefinin oluşturmuştur. Yöntemler: 114 adet daha önceden AF tanısı olmayan akut iskemik inme tanılı hasta çalışmaya dahil edildi. Hastaların kan paremetreleri ve kullandığı ilaçlar kaydedildi. Hastalara EKO yapılarak TAPSE/PASP oranı elde edildi. Her hastanın 24 saatlik ritm holter analizi yapıldı. PAF atağı 2 kategoriye ayrıldı. ((i) PAF atağı izlenmedi (İİ) PAF atağı izlendi). TAPSE/PASP oranı ile PAF’ın varlığı istatistiksel olarak incelendi. Bulgular: TAPSE/PASP oranı ritm holterde PAF tespit edilen grupta 0,62 ± 0,07, tespit edilmeyen grupta 0,77 ± 0,08 olarak tespit edilerek istatiksel olarak anlamlı olduğu görülmüştür. ROC analizinde, TAPSE/PASP oranı PAF’ı öngörmede tanısal bir değere sahipti (ROC eğrisinin altındaki alan [AUC]: 0,89, %82,7, p<0,001). Başvuru sırasında ölçülen TAPSE/PASP oranını 0,67’in altında tespit edilmesi PAF’ı öngörmede %87,1 duyarlılığa ve %82,7 özgüllüğe sahip olduğu bulundu. Çok değişkenli analizde TAPSE/PASP oranı (Odds Ratio [OR]: 2,971, %95 güven aralığı [CI] 1.073-8,959; p=0,000) PAF için anlamlı bir risk faktörü olarak bulundu. Sonuç: Çalışmamız TAPSE/PASP oranının düşük saptanmasının (<0.67) hastalarda PAF tanısının da olabileceğini düşünmemiz gerektiğini göstermektedir.

Keywords

• Akut iskemik inme
• TAPSE/ PASP oranı
• Paroksismal Atriyal fibrilasyon

The role of the TAPSE/PASP ratio in the prediction of paroxysmal atrial fibrillation in patients with acute ischemic stroke

Abstract

Aims: Atrial fibrillation (AF) remains the most prevalent cause of cardioembolic stroke. Paroxysmal AF (PAF) is often difficult to be diagnosed and is sometimes first detected during embolic stroke. Yet, TAPSE and PASP can be easily revealed in routine transthoracic echocardiography (TTE). Then, the TAPSE/PASP ratio is often shown to have prognostic significance in many cardiac disorders. Nevertheless, the insufficient scholarly knowledge of the relationship between this ratio and the development of PAF became the primary motive of the present study. Methods: We carried out this study with 114 patients experiencing acute ischemic stroke without a previous diagnosis of AF. We noted down the patients’ blood parameters and prescribed drugs and calculated TAPSE/PASP ratio relying on their TTE findings. We also recorded the 24-hour heart rhythm findings of each patient through Holter monitoring. After categorizing PAF attacks (i.e.,PAF attack was (not) observed), we explored any statistical relationship between the TAPSE/PASP ratio and the presence of PAF. Results: The findings revealed a significant difference between the TAPSE/PASP ratios between the groups with PAF (0.62±0.07) and without PAF (0.77±0.08). Moreover, the receiver operating characteristic (ROC) curve analysis yielded the TAPSE/PASP ratio to demonstrate a diagnostic value in predicting PAF (area under the ROC curve [AUC]=0.89;82.7%; p<0.001). Besides, the TAPSE/PASP ratio measured <0.67 at admission was found to have 87.1% sensitivity and 82.7% specificity in predicting PAF. Finally, the multivariate analysis showed the TAPSE/PASP ratio to be a significant risk factor for PAF (odds ratio [OR]=2.971;95% confidence interval [CI]=1.073-8.959; p=0.000). Conclusion: Overall, a low TAPSE/PASP ratio (<0.67) may be a precursor of the presence of PAF in patients.

Keywords

• Acute ischemic stroke
• tricuspid annular plane systolic excursion
• mean pulmonary artery systolic pressure
• paroxysmal atrial fibrillation

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