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[Ischemic cerebrovascular disease in patients with atrial fibrillation]
K Nakajima1, M Ichinose, S Takada
1Department of Internal Medicine, Asama General Hospital.
Insights
Patients with atrial fibrillation (Af) and valvular heart disease or hypertension face higher ischemic stroke risks. Antiplatelet therapy showed no significant benefit in preventing cerebrovascular disease (CVD) in chronic nonvalvular Af patients.
Area of Science:
- Cardiology
- Neurology
- Clinical Research
Background:
- Atrial fibrillation (Af) is a common arrhythmia associated with an increased risk of ischemic cerebrovascular disease (CVD).
- Identifying high-risk subgroups and understanding the timing of CVD events are crucial for effective prevention strategies.
- The role of antiplatelet therapy in nonvalvular Af requires further clarification.
Purpose of the Study:
- To identify patient subgroups with atrial fibrillation (Af) at higher risk for ischemic cerebrovascular disease (CVD).
- To determine if a vulnerable period exists for CVD occurrence after the diagnosis of chronic Af.
- To evaluate the clinical efficacy of antiplatelet therapy in preventing CVD in chronic nonvalvular Af patients.
Main Methods:
- Retrospective study analyzing data from 479 patients with atrial fibrillation (Af) over 9 years.
- Patients were categorized into paroxysmal Af, Af that converted from paroxysmal to chronic, and chronic Af groups.
- Subgroup analysis included assessment of valvular heart disease (VHD), hypertension, mitral valve prolapse syndrome, hyperthyroidism, and age.
Main Results:
- High-risk subgroups for CVD included chronic Af with valvular heart disease (VHD) or hypertension (incidence rate >6/100 person-years).
- Low-risk subgroups (<2/100 person-years) were paroxysmal Af under 60 years, chronic Af with mitral valve prolapse syndrome, or hyperthyroidism.
- No specific vulnerable period for CVD was identified during the 9-year follow-up, and antiplatelet therapy did not show a significant difference in CVD incidence compared to no therapy.
Conclusions:
- Chronic Af patients with concomitant valvular heart disease or hypertension represent a high-risk group for ischemic cerebrovascular disease (CVD).
- The occurrence of CVD in atrial fibrillation (Af) patients does not appear to be confined to a specific vulnerable period post-diagnosis.
- Current antiplatelet therapy strategies may not significantly reduce cerebrovascular disease (CVD) incidence in chronic nonvalvular Af patients.
Abstract:
The purpose of this retrospective study was to elucidate 1) which subgroups are prone to have ischemic cerebrovascular disease (CVD) among patients with atrial fibrillation (Af), 2) vulnerable period of CVD after the diagnosis of chronic Af and 3) the clinical efficacy of antiplatelet therapy in chronic nonvalvular Af patients. During 9 years, a total of 479 patients included 124 cases with paroxysmal Af, 30 cases with paroxysmal Af initially which later changed to chronic Af and 325 cases with chronic Af were enrolled. Among these 355 cases with chronic Af, 57 cases had valvular heart disease (VHD). The results were as follows: 1) The high risk subgroups (incidence rate/100 person-years is more than 6) were chronic Af with VHD or hypertension. The low risk subgroups (less than 2) were paroxysmal Af under 60 years of age, chronic Af with mitral valve prolapse syndrome or with hyperthyroidism. 2) There was no vulnerable period for occurrence of CVD during 9 years' follow-up from the onset of Af. 3) No significant difference in the incidence of CVD was seen in the groups with antiplatelet therapy and without.