Echocardiographic and clinical risk factors for atrial fibrillation in hypertensive patients with ischemic stroke
Haft JI et al. – Hypertensive pts with echocardiographic and clinical risk factors should undergo prolonged electrocardiographic event monitoring to identify occult intermittent atrial fibrillation (AF) to aid prevention of a second stroke and possibly a first stroke. Methods- Retrospective study of 799 pts admitted with ischemic stroke over 31 mo to determine the importance of AF in nonhemorrhagic stroke
Results- AF present on admitting electrocardiogram in 154 pts (19.3%), diagnosed later during stroke admission in 58 (7.3%), and found only during another admission before/after the stroke admission in 46 (5.8%)
- AF intermittent in 123 pts, 47.7% of AF pts, and not present on initial electrocardiogram in 40.3% of pts with AF
- In 633 hypertensive pts, AF occurred in 34.9% vs 22.2% without hypertension
- In pts with AF vs without AF, echocardiogram showed a left atrium ≥4 cm in 81.3% vs 42.4%; ejection fraction<50% in 27.7% vs 12.6%; left ventricle ≥5.6 cm in 13.8% vs 6.7%
- Clinically, congestive heart failure (31% vs 10.4%) and coronary disease (31% vs 21.4%) more often present in AF pts
- Left ventricular hypertrophy, diastolic dysfunction, and diabetes common in all hypertensive pts with stroke
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