Neslihan Başçıl TÜTÜNCÜ, Mehmet Bülent ÖZİN, Kerem Can YILMAZ, Özlem TURHAN İYİDİR, Orçun ÇİFTCİ, Suzan KESKİN, Lala RAMAZANOVA, Yusuf BOZKUŞ, Emir KARAÇAĞLAR, İbrahim Haldun MÜDERRİSOĞLU, Mustafa YILMAZ

Tip 2 Diyabetik Hastalarda 24 Saatlik Ritim Monitörizasyonunda Paroksismal Atriyal Fibrilasyon Sıklığını Belirlemede CHA2 DS2 VASC Skorunun ve Diabetes Mellitusla İlgili Demografik ve Klinik Faktörlerin Rolü

Amaç: Diabetes mellitus atriyal fibrilasyon ve tromboembolizm için risk faktörüdür. CHA2DS2 VASC skoru atriyal fibrilasyonda tromboemboli riskinigösteren bir skorlama sistemidir. Atriyal fibrilasyon risk faktörlerini de içeren bir sınıflama sistemi olduğundan atriyal fibrilasyon riskinde artışı da gösteriyor olabilir. Bu çalışmada, tip 2 diyabetiklerde CHA2DS2 VASC skorunun ve diyabetle ilgili faktörlerin 24 saatlik ritim monitörizasyonundaatriyal fibrilasyon sıklığını tespit etmedeki rolünü araştırdık.Gereç ve Yöntem: Ocak 2012 ve Ocak 2017 tarihleri arasında Başkent Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı’nda 24 saat ritimmonitörizasyonu yapılan >18 yaş tip 2 diyabeti olan erişkin hastalar geriye dönük dahil edildiler. CHA2DS2 VASC skoru ve demografik veriler,klinik parametreler, transtorasik ekokardiyografiler kaydedildi. Paroksismal atriyal fibrilasyon ve çalışma parametreleri arasındaki ilişki korelasyonanalizleri ile araştırıldı. Atriyal fibrilasyon ile bağımsız ilişkili parametreler çok değişkenli analiz ile test edildi. Anlamlı parametreler için alıcı işletim karakteristiği (ROC) eğrileri çizdirilerek en uygun kesim değerlerine bulundu.Bulgular: Toplam 378 hastanın 65 (%17,2’sinde) paroksismal atriyal fibrilasyon vardı. Atriyal fibrilasyon olan grupta CHA2DS2 VASC skoru anlamlışekilde yüksekti. Paroksismal atriyal fibrilasyonlu hastalar anlamlı şekilde daha yaşlı, daha uzun süredir diyabetli, daha geniş sol atriyal çapa sahiptiler.Tek değişkenli analizlerde atriyal fibrilasyon ile ilişkili parametreler yaş, diyabet süresi, CHA2DS2 VASC skoru ve sol atriyal çaptı. CHA2 DS2 VASC skoruçok değişkenli analizde 24 saatlik ritim monitörizasyonunda paroksismal atriyal fibrilasyonun bağımsız prediktörüydü. CHA2DS2 VASC skoru ≥3 olanhastalar daha düşük skora sahip hastalara göre atriyal fibrilasyon hızı anlamlı şekilde daha fazlaydı.Sonuç: Tip 2 diyabetik hastalarda CHA2DS2 VASC skoru 24 saatlik ritim monitörizasyonunda atriyal fibrilasyonun anlamlı prediktörüdür. YüksekCHA2 DS2 VASC skoru olan tip 2 diyabetiklerde atriyal fibrilasyon varlığı akla getirilmelidir. Bu konuda randomize kontrollü araştırmalara gereksinim vardır.

The Role of CHA2 DS2 VASC Score and Diabetes-Related Demographic and Clinical Factors for Determining the İncidence of Paroxysmal Atriyal Fibrillation in 24 Hour Rhythm Monitoring in Patients with Type 2 Diabetes Mellitus

Objectives: Diabetes mellitus is a risk factor for atrial fibrillation and thromboembolism. CHA2 DS2 VASC score is a scoring system indicating risk of thromboembolism in atrial fibrillation. As it also includes risk factors for atrial fibrillation, it may also indicate a heightened atrial fibrillation risk. Herein, we investigated the role of CHA2 DS2 VASC score and diabetes-related factors for determining paroxysmal atrial fibrilallation incidence in 24-hour rhythm monitorization among type 2 diabetic patients. Materials and Methods: We retrospectively analyzed type 2 diabetic patients older than 18 years of age who underwent 24-hour rhythm monitoring at Başkent University, Faculty of Medicine, Department of Cardiology between January 2012 and January 2017. The patients’ CHA2 DS2 VASC score, clinical and demographic parameters, transthoracic echocardiography findings were recorded. The correlation between paroxysmal atrial fibrillation and study parameters was analyzed. Multivariate analysis was used to determine significant independent predictors of atrial fibrillation. ROC analysis was done to determine the best cut-off points for significant predictors of atrial fibrillation. Results: A total of 65 (17.2%) of 378 patients had atrial fibrillation in 24-hour rhythm monitoring. The patients with atrial fibrillation had a significantly greater CHA2 DS2 VASC score. The patients with atrial fibrillation were significantly older, had a longer diabetes duration, and a larger left atrium. Age, diabetes duration, CHA2 DS2 VASC score, and left atrial diameter were significantly correlated with atrial fibrillation while CHA2 DS2 VASC score was a significant independent predictor of paroxysmal atrial fibrillation in 24-hour rhythm monitoring. The patients with a CHA2 DS2 VASC score of equal to or greater than 3 had a significantly greater incidence of paroxysmal atrial fibrillation. Conclusion: Among type 2 diabetics, CHA2 DS2 VASC score is a significant predictor of atrial fibrillation in 24-hour rhythm monitoring. Atrial fibrillation should be suspected in type 2 diabetics with a high CHA2 DS2 VASC score. Randomized controlled studies are needed in this field.

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Benjamin EJ, Levy D, Vaziri SM, et al. Independent risk factors for atriyal fibrillation in a population-based cohort. The Framingham Heart Study. JAMA. 1994;271:840.
Devereux RB, Roman MJ, Paranicas M, et al. Impact of diyabetes on cardiac structure and function: the strong heart study. Circulation. 2000;101:2271.
Lip GY, Nieuwlaat R, Pisters R, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atriyal fibrillation using a novel risk factor-based approach: the euro heart survey on atriyal fibrillation. Chest. 2010;137:263-272.
Lodder J, Bamford JM, Sandercock PA, et al. Are hypertension or cardiac embolism likely causes of lacunar infarction? Stroke. 1990;21:375-381.
Enis J. Stroke prevention in patients with non-valvular atriyal fibrillation: a current community perspective. Journal of Clinical Neuroscience Volume 4, Issue 3, July 1997, Pages 320-325.
Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines forthe management of atriyalfibrillation developed in collaboration with EACTS. Europace. 2016 ;18:1609-1678.
Barkas F, Elisaf M, Korantzopoulos P, et al. The CHADS2 and CHA2DS2- VASc scores predict atriyal fibrillation in dyslipidemic individuals: Role of incorporating low high-density lipoprotein cholesterol levels. Int J Cardiol. 2017;241:194-199.
Saliba W, Gronich N, Barnett-Griness O, et al. Usefulness of CHADS2 and CHA2DS2-VASc Scores in the Prediction of New-Onset AtriyalFibrillation: A Population-Based Study. Am J Med. 2016;129:843-849.
Zuo ML, Liu S, Chan KH, et al. The CHADS2 and CHA2DS2VASc scorespredict new occurrence of atriyalfibrillation and ischemic stroke. J Interv Card Electrophysiol. 2013;37:47-54.
Baturova MA, Lindgren A, Carlson J, et al. Predictors of new onset atriyal fibrillation during 10-year follow-up after first-ever ischemic stroke. Int J Cardiol. 2015;199:248-252.
Lévy S. Factors predisposing to the development of atriyal fibrillation. Pacing Clin Electrophysiol. 1997;20:2670-2674.
Krahn AD, Manfreda J, Tate RB, et al. The natural history of atriyal fibrillation: incidence, risk factors, and prognosis in the Manitoba FollowUp Study. Am J Med. 1995;98:476-484.
Chugh SS, Blackshear JL, Shen WK, et al. Epidemiology and natural history of atriyal fibrillation: clinical implications. J Am Coll Cardiol 2001;37:371.
Feinberg WM, Blackshear JL, Laupacis A, et al. Prevalence, age distribution, and gender of patients with atriyal fibrillation. Analysis and implications. Arch Intern Med. 1995;155:469.
Heeringa J, van der Kuip DA, Hofman A, et al. Prevalence, incidence and lifetime risk of atriyal fibrillation: the Rotterdam study. Eur Heart J. 2006;27:949.
Santhanakrishnan R, Wang N, Larson MG, et al. Atriyal Fibrillation Begets Heart Failure and Vice Versa: Temporal Associations and Differences in Preserved Versus Reduced Ejection Fraction. Circulation. 2016;133:484.
Crenshaw BS, Ward SR, Granger CB, et al. Atriyal fibrillation in the setting of acute myocardial infarction: the GUSTO-I experience. Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries. J Am Coll Cardiol. 1997;30:406.
Wong CK, White HD, Wilcox RG, et al. New atriyal fibrillation after acute myocardial infarction independently predicts death: the GUSTO-III experience. Am Heart J. 2000;140:878.
Eldar M, Canetti M, Rotstein Z, et al. Significance of paroxysmal atriyal fibrillation complicating acute myocardial infarction in the thrombolytic era. SPRINT and Thrombolytic Survey Groups. Circulation. 1998;97:965.