Patients With Ischemic Stroke And Atrial Fibrillation

ObjectiveThe incidence of ischemic stroke is increasing year by year,and it is now the second cause of death worldwide.Atrial fibrillation increases the incidence of ischemic stroke by 3 to 5 times,and ischemic stroke patients with atrial fibrillation have more severe dysfunction than those without atrial fibrillation,and higher disability and mortality rates.Atrial fibrillation is closely related to the size of the left atrium and the control of ventricular rate.In recent years,there has been controversy about the correlation between heart-related parameters and stroke.As strokes associated with atrial fibrillation often have large infarct size and severe disease,anterior circulation non-lacunar infarctions can be divided into two categories according to OCSP classification:complete anterior circulation infarction and partial anterior circulation infarction.The level of the NIHSS score can be divided into three groups:mild neurological impairment,moderate neurological impairment,and severe neurological impairment.The prognosis can be divided into three groups according to the modified Rankin Scale(mRS)score at the time of discharge.Three groups were good,poor prognosis,and death.To understand the relationship between heart rate,left atrial diameter(LAD)and stroke classification,severity,and prognosis in patients with ischemic stroke with non-valvular atrial fibrillation(NVAF),and provide new ideas for studying the clinical characteristics of ischemic stroke The idea is to better prevent the occurrence of stroke clinically,guide the treatment of stroke,and evaluate the prognosis of patients.MethodsA retrospective collection of 155 patients with ischemic stroke and NVAF in the department of Neurology,Zhongda Hospital,Southeast University from January 2017 to December 2019.Record the basic information of the enrolled patients:gender,age,smoking history,drinking history,high blood pressure,diabetes;laboratory tests:low density lipoprotein(LDL),high density lipoprotein(HDL),triglycerides(TG),D-dimer;ventricular rate on the ECG on admission;NIHSS score on admission;echocardiogram related parameters during hospitalization:LAD,left ventricular ejection fraction(LVEF);based on the patient’s clinical manifestations,neurological examination,and admission The complete anterior circulation infarct type and partial anterior circulation infarction type in the stroke classification determined by the infarct location,scope and vascular condition shown by posterior head MRI;mRS score at discharge.Compare patients’ basic data,laboratory examinations,heart-related parameters in stroke classification,NIHSS score at admission,and mRS score at discharge.Results1.In the comparison of basic data,laboratory examinations,and heart-related parameters between the complete anterior circulation infarction group and the partial anterior circulation infarction group,it was found that there were statistical differences between the two groups in D-dimer,hypertension,LAD,and heart rate(P<0.05).The results of multivariate logistic regression analysis of anterior circulation infarction classification suggest that the independent influencing factors of anterior circulation infarction classification are LAD(OR=5.361,P<0.05),heart rate(OR=1.031,P<0.05),and large The left atrial diameter and fast heart rate are independent risks of complete anterior circulation infarction.ROC analysis showed that the area under the ROC curve for the prediction of anterior circulation infarction classification by heart rate combined with left atrial diameter was 0.768(95%CI:0.689-0.846,P<0.05),and the combination of the two had a higher efficiency in prediction.2.The comparison between the heart-related parameters and the NIHSS score at admission indicates that the size of LAD(R=0.324,P<0.05),the speed of heart rate(R=0.188,P<0.05)and the NIHSS score at admission are statistically different and positive Related.The comparison between the heart-related parameters and the degree of neurological deficit assessed based on the NIHSS score suggests that the LAD size and heart rate are statistically different between the degree of mild to severe neurological damage and the degree of moderate to severe neurological damage(P<0.05).There was no statistical difference in the degree of mild to moderate nerve damage(P>0.05).There was no statistical difference between the cardiac related parameters and the different prognosis degrees(P>0.05)ConclusionLAD and heart rate of patients with ischemic stroke with NVAF are independent influencing factors of two stroke subtypes:complete anterior circulation infarction and partial anterior circulation infarction,and large left atrial diameter and fast heart rate are independent risks of complete anterior circulation infarction.In addition,the larger the LAD,the faster the heart rate at admission,the more severe the patient’s stroke,and the higher the NIHSS score at admission.However,complete anterior circulation infarction is often severe,progressing rapidly,accumulated large blood vessels,large infarct area,and poor collateral circulation.Therefore,understanding LAD and heart rate can help early identification of high-risk patients with stroke,and early intervention to prevent stroke occurrence and evaluation The patient’s prognosis also provides a new perspective for clinically assessing the severity of stroke.In the individualized treatment of patients with atrial fibrillation combined with left atrial dilation to prevent ischemic stroke,the treatment plan can be optimized according to the size of the left atrium.