cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2022.1.n1777cardio-1777Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИRESEARCH ARTICLESПредикторы возникновения фибрилляции предсердий у пациентов с ишемическим инсультом неопределенной этиологииPredictors of atrial fibrillation in patients with ischemic stroke of undetermined etiologyhttps://orcid.org/0000-0002-9011-2879РахимоваИ. Р.RakhimovaI. R.

ассистент кафедры

department assistant

idalya111@mail.ruhttps://orcid.org/0000-0003-1886-0538ХайбуллинТ. Н.KhaibullinT. N.

профессор кафедры неврологии, офтальмологии и отоларингологии, д.м.н., профессор

professor, M.D.,  Ph.D.

htn2006@mail.ruhttps://orcid.org/0000-0002-1004-2162КовальчукВ. В.KovalchukV. V.

заведующий отделением реабилитации пациентов с нарушением функций ЦНС, профессор Кембриджского Университета, д.м.н., профессор

professor, M.D.,  Ph.D.

vikoval67@mail.ruhttps://orcid.org/0000-0003-1324-7806СеменоваЮ. М.SemenovaYu. M.

заведующая кафедрой неврологии, офтальмологии и отоларингологии, к.м.н., профессор

professor, M.D.,  Ph.D.

yumsem@mail.ruhttps://orcid.org/0000-0001-6315-5016АбдрахмановА. С.AbdrakhmanovA. S.

заведующий отделением интервенционной аритмологии, д.м.н., профессор

professor, M.D.,  Ph.D.

ayan-3@mail.ruНАО Медицинский университет Семей, г. Семей, КазахстанКазахстанNJSC Semey Medical University, Semey, KazakhstanKazakhstanКембриджский университет, Кембридж, ВеликобританияВеликобританияUniversity of Cambridge, Cambridge, Great BritainUnited KingdomНациональный научный кардиохирургический центр, Нур-Султан, КазахстанКазахстанNational research cardiac surgery center, Nur-Sultan, KazakhstanKazakhstan2022310120226214045Copyright © Kardiomag, 20222022KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/1777

Цель    Определение комплекса предикторов и создание математической модели прогнозирования возникновения фибрилляции предсердий (ФП) у пациентов с ишемическим инсультом неопределенной этиологии.Материал и методы    В исследование включен 981 пациент с ишемическим инсультом. Рассматривалось влияние следующих факторов: пол, наличие инсульта в анамнезе, наличие тромбоэмболии в анамнезе, наличие сахарного диабета, степень артериальной гипертензии, функциональный класс (ФК) хронической сердечной недостаточности (ХСН), возраст, данные биохимического анализа крови, данные коагулограммы. При построении прогностической модели была использована бинарная логистическая регрессия. Рассчитано значение площади под ROC-кривой для предложенной прогностической модели.Результаты    Основными предикторами развития ФП у пациентов с ишемическим инсультом неопределенной этиологии явились: ФК ХСН, инсульт в анамнезе, возраст, пол, уровень холестерина и протромбиновый индекс, которые вошли в итоговую прогностическую модель. Чувствительность разработанной модели составила 83,5 %, специфичность – 85,5 %. Площадь под ROC-кривой, соответствующей взаимосвязи прогноза фибрилляции предсердий и значения регрессионной функции, составила 0,921±0,012 с 95 % доверительным интервалом: 0,898–0,944.Заключение    Согласно полученным данным, вероятность наличия ФП у пациентов с ишемическим инсультом увеличивалась при прогрессировании ХСН, повторном инсульте, увеличении возраста, принадлежности к женскому полу, а также при снижении протромбинового индекса и уровня холестерина.

Aim    To identify a complex of predictors and to create a mathematical model for prognosis of atrial fibrillation (AF) in patients with ischemic stroke of undetermined etiology. Material and methods    The study included 981 patients with ischemic stroke. Effects of the following factors were evaluated: gender, a history of stroke, a history of thromboembolism, presence of diabetes mellitus, grade of arterial hypertension, functional class (FC) of chronic heart failure (CHF), age, data of blood biochemistry, and data of coagulogram. The prognostic model was constructed using the binary logistic regression. The value of area under the ROC curve for the proposed prognostic model was calculated.Results    The main predictors of AF in patients with ischemic stroke of undetermined etiology were CHF FC, a history of stroke, age, gender, values of cholesterol and prothrombin index, which were included into the final prognostic model. The sensitivity of the developed model was 83.5 % and the specificity was 85.5 %. The area under the ROC curve corresponding to the interrelation between the prognosis of AF and the regression function value was 0.921±0.012 with 95 % confidence interval: 0.898–0.944.Conclusion    According to the results of the study, the probability of AF in patients with ischemic stroke increased with CHF progression, recurrent stroke, older age, female gender, and reduced prothrombin index and cholesterol level.

Фибрилляция предсердийинсульт неопределенной этиологиикриптогенный инсультмодель прогнозированияAtrial fibrillationstroke of undetermined etiologycryptogenic strokeprognostic modelКонфликт интересов не заявлен.No conflict of interest is reported.ReferencesFeigin VL, Brainin M, Norrving B, Martins S, Sacco RL, Hacke W et al. World Stroke Organization (WSO): Global Stroke Fact Sheet 2022. International Journal of Stroke. 2022;17(1):18–29. DOI: 10.1177/17474930211065917Feigin VL, Brainin M, Norrving B, Martins S, Sacco RL, Hacke W et al. World Stroke Organization (WSO): Global Stroke Fact Sheet 2022. International Journal of Stroke. 2022;17(1):18–29. DOI: 10.1177/17474930211065917Kim J, Thayabaranathan T, Donnan GA, Howard G, Howard VJ, Rothwell PM et al. Global Stroke Statistics 2019. International Journal of Stroke. 2020;15(8):819–38. DOI: 10.1177/1747493020909545Feigin VL, Brainin M, Norrving B, Martins S, Sacco RL, Hacke W et al. World Stroke Organization (WSO): Global Stroke Fact Sheet 2022. International Journal of Stroke. 2022;17(1):18–29. DOI: 10.1177/17474930211065917Krishnamurthi RV, Moran AE, Feigin VL, Barker-Collo S, Norrving B, Mensah GA et al. Stroke Prevalence, Mortality and Disability-Adjusted Life Years in Adults Aged 20-64 Years in 1990-2013: Data from the Global Burden of Disease 2013 Study. Neuroepidemiology. 2015;45(3):190–202. DOI: 10.1159/000441098Kim J, Thayabaranathan T, Donnan GA, Howard G, Howard VJ, Rothwell PM et al. Global Stroke Statistics 2019. International Journal of Stroke. 2020;15(8):819–38. DOI: 10.1177/1747493020909545Chong JY, Sacco RL. Epidemiology of Stroke in Young Adults: Race/Ethnic Differences. Journal of Thrombosis and Thrombolysis. 2005;20(2):77–83. DOI: 10.1007/s11239-005-3201-9Krishnamurthi RV, Moran AE, Feigin VL, Barker-Collo S, Norrving B, Mensah GA et al. Stroke Prevalence, Mortality and Disability-Adjusted Life Years in Adults Aged 20-64 Years in 1990-2013: Data from the Global Burden of Disease 2013 Study. Neuroepidemiology. 2015;45(3):190–202. DOI: 10.1159/000441098Thrift AG, Thayabaranathan T, Howard G, Howard VJ, Rothwell PM, Feigin VL et al. Global stroke statistics. International Journal of Stroke. 2017;12(1):13–32. DOI: 10.1177/1747493016676285Chong JY, Sacco RL. Epidemiology of Stroke in Young Adults: Race/Ethnic Differences. Journal of Thrombosis and Thrombolysis. 2005;20(2):77–83. DOI: 10.1007/s11239-005-3201-9Министерство Здравоохранения Республики Казахстан. Здоровье населения Республики Казахстан и деятельность организаций здравоохранения в 2014-2018гг. Статистические сборники. Доступно на: http://www.rcrz.kz/index.php/ru/statistika-zdravookhraneniya-2Thrift AG, Thayabaranathan T, Howard G, Howard VJ, Rothwell PM, Feigin VL et al. Global stroke statistics. International Journal of Stroke. 2017;12(1):13–32. DOI: 10.1177/1747493016676285Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP et al. Heart Disease and Stroke Statistics–2020 Update: A Report From the American Heart Association. Circulation. 2020;141(9):e139–596. DOI: 10.1161/CIR.0000000000000757Ministry of Health of the Republic of Kazakhstan. The health of the population of the Republic of Kazakhstan and the activities of healthcare organizations in 2014-2018. Statistical collections. Av. at: http://www.rcrz.kz/index.php/ru/statistika-zdravookhraneniya-2.Fonseca AC, Ferro JM. Cryptogenic stroke. European Journal of Neurology. 2015;22(4):618–23. DOI: 10.1111/ene.12673Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP et al. Heart Disease and Stroke Statistics–2020 Update: A Report From the American Heart Association. Circulation. 2020;141(9):e139–596. DOI: 10.1161/CIR.0000000000000757Watson T, Shantsila E, Lip GYH. Mechanisms of thrombogenesis in atrial fibrillation: Virchow’s triad revisited. The Lancet. 2009;373(9658):155–66. DOI: 10.1016/S0140-6736(09)60040-4Fonseca AC, Ferro JM. Cryptogenic stroke. European Journal of Neurology. 2015;22(4):618–23. DOI: 10.1111/ene.12673Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22(8):983–8. DOI: 10.1161/01.STR.22.8.983Watson T, Shantsila E, Lip GYH. Mechanisms of thrombogenesis in atrial fibrillation: Virchow’s triad revisited. The Lancet. 2009;373(9658):155–66. DOI: 10.1016/S0140-6736(09)60040-4Shafqat S, Kelly PJ, Furie KL. Holter monitoring in the diagnosis of stroke mechanism: Holter monitoring in stroke. Internal Medicine Journal. 2004;34(6):305–9. DOI: 10.1111/j.1444-0903.2004.00589.xWolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22(8):983–8. DOI: 10.1161/01.STR.22.8.983Schuchert A, Behrens G, Meinertz T. Impact of Long-Term ECG Recording on the Detection of Paroxysmal Atrial Fibrillation in Patients After an Acute Ischemic Stroke. Pacing and Clinical Electrophysiology. 1999;22(7):1082–4. DOI: 10.1111/j.1540-8159.1999.tb00574.xShafqat S, Kelly PJ, Furie KL. Holter monitoring in the diagnosis of stroke mechanism: Holter monitoring in stroke. Internal Medicine Journal. 2004;34(6):305–9. DOI: 10.1111/j.1444-0903.2004.00589.xJabaudon D, Sztajzel J, Sievert K, Landis T, Sztajzel R. Usefulness of Ambulatory 7-Day ECG Monitoring for the Detection of Atrial Fibrillation and Flutter After Acute Stroke and Transient Ischemic Attack. Stroke. 2004;35(7):1647–51. DOI: 10.1161/01.STR.0000131269.69502.d9Schuchert A, Behrens G, Meinertz T. Impact of Long-Term ECG Recording on the Detection of Paroxysmal Atrial Fibrillation in Patients After an Acute Ischemic Stroke. Pacing and Clinical Electrophysiology. 1999;22(7):1082–4. DOI: 10.1111/j.1540-8159.1999.tb00574.xPecha S, Wilke I, Yildirim Y, Reichenspurner H, Aydin MA. Implantable loop recorder monitoring in patients with cryptogenic stroke - Detection and treatment of different clinically relevant arrhythmias. Journal of Electrocardiology. 2020; 60:102–6. DOI: 10.1016/j.jelectrocard.2020.04.007Jabaudon D, Sztajzel J, Sievert K, Landis T, Sztajzel R. Usefulness of Ambulatory 7-Day ECG Monitoring for the Detection of Atrial Fibrillation and Flutter After Acute Stroke and Transient Ischemic Attack. Stroke. 2004;35(7):1647–51. DOI: 10.1161/01.STR.0000131269.69502.d9Poli S, Diedler J, Härtig F, Götz N, Bauer A, Sachse T et al. Insertable cardiac monitors after cryptogenic stroke - a risk factor based approach to enhance the detection rate for paroxysmal atrial fibrillation. European Journal of Neurology. 2016;23(2):375–81. DOI: 10.1111/ene.12843Pecha S, Wilke I, Yildirim Y, Reichenspurner H, Aydin MA. Implantable loop recorder monitoring in patients with cryptogenic stroke - Detection and treatment of different clinically relevant arrhythmias. Journal of Electrocardiology. 2020; 60:102–6. DOI: 10.1016/j.jelectrocard.2020.04.007Клинический протокол диагностики и лечения. Ишемический инсульт. 2016. Доступно на: http://www.rcrz.kz/docs/clinic_protocol/2016/2пг/Терапия/Невропатология/8Ишемическийинсульт.pdfPoli S, Diedler J, Härtig F, Götz N, Bauer A, Sachse T et al. Insertable cardiac monitors after cryptogenic stroke - a risk factor based approach to enhance the detection rate for paroxysmal atrial fibrillation. European Journal of Neurology. 2016;23(2):375–81. DOI: 10.1111/ene.128432018 ESC/ESH Guidelines for the management of arterial hypertension. Revista Española de Cardiología (English Edition). 2019;72(2):160. DOI: 10.1016/j.rec.2018.12.004Clinical protocol of diagnosis and treatment. Ischemic stroke. 2016. Av. at: http://www.rcrz.kz/docs/clinic_protocol/2016/2пг/Терапия/Невропатология/8Ишемическийинсульт.pdf.Van der Meer P, Gaggin HK, Dec GW. ACC/AHA Versus ESC Guidelines on Heart Failure. Journal of the American College of Cardiology. 2019;73(21):2756–68. DOI: 10.1016/j.jacc.2019.03.4782018 ESC/ESH Guidelines for the management of arterial hypertension. Revista Española de Cardiología (English Edition). 2019;72(2):160. DOI: 10.1016/j.rec.2018.12.004International Diabetes Federation Guideline Development Group. Global Guideline for Type 2 Diabetes. Diabetes Research and Clinical Practice. 2014;104(1):1–52. DOI: 10.1016/j.diabres.2012.10.001Van der Meer P, Gaggin HK, Dec GW. ACC/AHA Versus ESC Guidelines on Heart Failure. Journal of the American College of Cardiology. 2019;73(21):2756–68. DOI: 10.1016/j.jacc.2019.03.478Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal. 2016;37(38):2893–962. DOI: 10.1093/eurheartj/ehw210International Diabetes Federation Guideline Development Group. Global Guideline for Type 2 Diabetes. Diabetes Research and Clinical Practice. 2014;104(1):1–52. DOI: 10.1016/j.diabres.2012.10.001Riordan M, Opaskar A, Yoruk A, Younis A, Ali A, McNitt S et al. Predictors of Atrial Fibrillation During Long‐Term Implantable Cardiac Monitoring Following Cryptogenic Stroke. Journal of the American Heart Association. 2020;9(15). DOI: 10.1161/JAHA.120.016040Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal. 2016;37(38):2893–962. DOI: 10.1093/eurheartj/ehw210Börschel CS, Ohlrogge AH, Geelhoed B, Niiranen T, Havulinna AS, Palosaari T et al. Risk prediction of atrial fibrillation in the community combining biomarkers and genetics. EP Europace. 2021;23(5):674– 81. DOI: 10.1093/europace/euaa334Riordan M, Opaskar A, Yoruk A, Younis A, Ali A, McNitt S et al. Predictors of Atrial Fibrillation During Long‐Term Implantable Cardiac Monitoring Following Cryptogenic Stroke. Journal of the American Heart Association. 2020;9(15). DOI: 10.1161/JAHA.120.016040Tsioufis C, Konstantinidis D, Nikolakopoulos I, Vemmou E, Kalos T, Georgiopoulos G et al. Biomarkers of Atrial Fibrillation in Hypertension. Current Medicinal Chemistry. 2019;26(5):888–97. DOI: 10.2174/0929867324666171006155516Börschel CS, Ohlrogge AH, Geelhoed B, Niiranen T, Havulinna AS, Palosaari T et al. Risk prediction of atrial fibrillation in the community combining biomarkers and genetics. EP Europace. 2021;23(5):674– 81. DOI: 10.1093/europace/euaa334Westerman S, Wenger N. Gender Differences in Atrial Fibrillation: A Review of Epidemiology, Management, and Outcomes. Current Cardiology Reviews. 2019;15(2):136–44. DOI: 10.2174/1573403X15666181205110624Tsioufis C, Konstantinidis D, Nikolakopoulos I, Vemmou E, Kalos T, Georgiopoulos G et al. Biomarkers of Atrial Fibrillation in Hypertension. Current Medicinal Chemistry. 2019;26(5):888–97. DOI: 10.2174/0929867324666171006155516Wu Y, Xie Z, Liang W, Xue R, Wu Z, Wu D et al. Usefulness of CHADS2, R2CHADS2, and CHA2DS2‐VASc scores for predicting incident atrial fibrillation in heart failure with preserved ejection fraction patients. ESC Heart Failure. 2021;8(2):1369–77. DOI: 10.1002/ ehf2.13217Westerman S, Wenger N. Gender Differences in Atrial Fibrillation: A Review of Epidemiology, Management, and Outcomes. Current Cardiology Reviews. 2019;15(2):136–44. DOI: 10.2174/1573403X15666181205110624Mazaris S, Siasos G, Oikonomou E, Tsigkou V, Vavuranakis M, Kokkou E et al. Atrial Fibrillation: Biomarkers Determining Prognosis. Current Medicinal Chemistry. 2019;26(5):909–15. DOI: 10.2174/0929867324666170727115642Wu Y, Xie Z, Liang W, Xue R, Wu Z, Wu D et al. Usefulness of CHADS2, R2CHADS2, and CHA2DS2‐VASc scores for predicting incident atrial fibrillation in heart failure with preserved ejection fraction patients. ESC Heart Failure. 2021;8(2):1369–77. DOI: 10.1002/ ehf2.13217Aydin M, Susam I, Kilicaslan B, Dereli M, Sacar M, Ozdogan O. Serum cholesterol levels and postoperative atrial fibrillation. Journal of Cardiothoracic Surgery. 2014;9(1):69. DOI: 10.1186/1749-8090-9-69Mazaris S, Siasos G, Oikonomou E, Tsigkou V, Vavuranakis M, Kokkou E et al. Atrial Fibrillation: Biomarkers Determining Prognosis. Current Medicinal Chemistry. 2019;26(5):909–15. DOI: 10.2174/0929867324666170727115642Magnussen C, Niiranen TJ, Ojeda FM, Gianfagna F, Blankenberg S, Njølstad I et al. Sex Differences and Similarities in Atrial Fibrillation Epidemiology, Risk Factors, and Mortality in Community Cohorts: Results from the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe). Circulation. 2017;136(17):1588– 97. DOI: 10.1161/CIRCULATIONAHA.117.028981Aydin M, Susam I, Kilicaslan B, Dereli M, Sacar M, Ozdogan O. Serum cholesterol levels and postoperative atrial fibrillation. Journal of Cardiothoracic Surgery. 2014;9(1):69. DOI: 10.1186/1749-8090-9-69Mora S, Akinkuolie AO, Sandhu RK, Conen D, Albert CM. Paradoxical Association of Lipoprotein Measures with Incident Atrial Fibrillation. Circulation: Arrhythmia and Electrophysiology. 2014;7(4):612– 9. DOI: 10.1161/CIRCEP.113.001378Magnussen C, Niiranen TJ, Ojeda FM, Gianfagna F, Blankenberg S, Njølstad I et al. Sex Differences and Similarities in Atrial Fibrillation Epidemiology, Risk Factors, and Mortality in Community Cohorts: Results from the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe). Circulation. 2017;136(17):1588– 97. DOI: 10.1161/CIRCULATIONAHA.117.028981Татаринцева З. Г., Космачева Е. Д. Дислипидемия у пациентов с фибрилляцией предсердий на фоне острого коронарного синдрома по данным регистра Краснодарского края. Инновационная медицина Кубани. 2019; 3:19-24. DOI: 10.35401/2500-0268-2019-15-3-19-24Mora S, Akinkuolie AO, Sandhu RK, Conen D, Albert CM. Paradoxical Association of Lipoprotein Measures with Incident Atrial Fibrillation. Circulation: Arrhythmia and Electrophysiology. 2014;7(4):612– 9. DOI: 10.1161/CIRCEP.113.001378Tatarintseva Z.G., Kosmacheva E.D. Dyslipidemia in patients with atrial fibrillation on the background of acute coronary syndrome according to the register of the Krasnodar region. Innovative medicine of Kuban. 2019; 3:19–24. DOI: 10.35401/2500-0268-2019-15-3-19-24Tatarintseva Z.G., Kosmacheva E.D. Dyslipidemia in patients with atrial fibrillation on the background of acute coronary syndrome according to the register of the Krasnodar region. Innovative medicine of Kuban. 2019; 3:19–24. DOI: 10.35401/2500-0268-2019-15-3-19-24

The authors declare that there are no conflicts of interest present.