AKUT SEREBROVASKÜLER OLAY GEÇİREN HASTALARDA ACEF RİSK SKORU İLE ARİTMİ GELİŞİMİ ARASINDAKİ İLİŞKİ

Giriş: Akut inmeden sonra yüksek riskli hastaların belirlenmesi, uygun kardiyak izlem ve altta yatan aritmilerin tanı ve tedavisi, kardiyak morbidite ve mortaliteyi önlemek için önemlidir. ACEF risk skoru, sadece kısa ve uzun vadeli mortalite açısından değil, aynı zamanda majör advers kardiyovasküler olaylar açısından da tatmin edici prediktif değerler ile ilişkilendirilmiştir. Bu çalışmanın amacı akut iskemik serebrovasküler olay (SVO) geçiren hastalarda ACEF risk skoru ile aritmi gelişimi arasındaki ilişkinin araştırılmasıdır. Gereç ve Yöntem: Çalışmaya, akut iskemik SVO geçiren, bazal elektrokardiyografisinde (EKG) aritmi bulunmayan ve aritmi tespiti için Holter EKG takılan ardışık 158 hasta dahil edilmiştir. Hastalar, Holter EKG’de aritmi saptanmayanlar (Grup 1) ve saptananlar (Grup 2) şeklinde iki gruba ayrılarak incelendi. ACEF skoru aşağıdaki formüle göre hesaplandı; ACEF = yaş/sol ventrikül ejeksiyon fraksiyonu+1 (kreatinin>2.0 mg/dL ise). Bulgular: Hastaların yaş ortalaması 71.6±10.6 yıldı ve grup II'deki yaş ortalaması grup I'e göre istatistiksel olarak anlamlı derecede yüksekti (72.8±10.1'e karşı 68.8±11.2 yıl, p=0.025). Hastaların 110'unda (%69.6) Holter EKG'de aritmi saptandı. En sık görülen aritmi tipi ventriküler ekstrasistoller (%32.7) idi. Ortalama ACEF skoru 1.43±0.49 olarak bulundu. ACEF risk skoru grup II'de grup I'e göre istatistiksel olarak anlamlı derecede daha yüksekti (1.497±0.511'e karşı 1.285±0.407, p=0.012). ACEF risk skoru değeri >1.26, %59 duyarlılık ve %56 özgüllük ile akut iskemik inmeli hastalarda aritmi için bir öngördürücü olarak saptandı (eğri altındaki ROC alanı: 0.642, %95 CI: 0.548-0.737, P =0.004 ). Sonuç: Akut iskemik SVO geçiren hastalarda yüksek ACEF risk skoru, holter EKG ile tespit edilen, altta yatan aritmi varlığı ile ilişkilidir. Bu hastalarda aritmi varlığını öngörmek için basit ve kolay ulaşılabilir ACEF risk skoru kullanılabilir.

THE RELATIONSHIP BETWEEN THE ACEF RISK SCORE AND THE DEVELOPMENT OF ARRHYTHMIA IN PATIENTS WITH ACUTE CEREBROVASCULAR EVENT

Introduction: Identification of high-risk patients after acute stroke, appropriate cardiac monitoring, and diagnosis and treatment of underlying arrhythmias are important to prevent cardiac morbidity and mortality. The ACEF risk score has been associated with satisfactory predictive values not only for short- and long-term mortality but also for major adverse cardiovascular events. The aim of this study is to investigate the relationship between the ACEF risk score and the development of arrhythmia in patients with acute ischemic cerebrovascular event (CVE). Materials and Methods: A total of 158 consecutive patients with acute ischemic CVE, without arrhythmia on baseline electrocardiography and who underwent Holter electrocardiography (ECG) were included in the study. The patients were divided into two groups as those without arrhythmia on Holter ECG (Group 1) and those with detected (Group 2). ACEF score was calculated according to the following formula; ACEF = age/left ventricular ejection fraction +1 (if creatinine >2.0 mg/dL). Results: The mean age of the patients was 71.6 (±10.6) years, and the mean age in group II was statistically significantly higher than in group I (72.8±10.1 vs. 68.8±11.2 years, p=0.025). Arrhythmia was detected in Holter ECG in 110 (69.6%) of the patients. The most common type of arrhythmia was ventricular extrasystole (32.7%). The mean ACEF score was 1.43(±0.49). ACEF risk score was statistically significantly higher in group II than group I (1.497±0.511 vs. 1.285±0.407, p=0.012). The ACEF risk score value was found to be a predictor of arrhythmia in patients with acute ischemic stroke with a >1.26, 59% sensitivity and 56% specificity (ROC area under curve: 0.642, 95% CI: 0.548-0.737, P =0.004). Conclusion: A high ACEF risk score in patients with acute ischemic CVE is associated with the presence of an underlying arrhythmia detected by Holter ECG. A simple and easily accessible risk score, ACEF, can be used to predict the presence of arrhythmia in these patients.

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1. Fernández-Menéndez S, García-Santiago R, Vega-Primo A, González Nafría N, Lara-Lezama LB, Redondo-Robles L et al. Cardiac arrhythmias in stroke unit patients. Evaluation of the cardiac monitoring data. Neurologia 2016; 31(5): 289-95.
2. Ruthirago D, Julayanont P, Tantrachoti P, Kim J, Nugent K. Cardiac Arrhythmias and Abnormal Electrocardiograms After Acute Stroke. Am J Med Sci 2016; 351(1): 112-8.
3. Arslan Y, Selbest Demirtaş B, Ekmekci C, Şener U. Investigation of risk factors in cryptogenic ischemic stroke. Turkish Journal of Cerebrovascular Diseases 2019; 25(1): 26-30.
4. Korpelainen JT, Sotaniemi KA, Huikuri HV, Myllylä VV. Circadian rhythm of heart rate variability is reversibly abolished in ischemic stroke. Stroke 1997; 28(11); 2150-4.
5. Britton M, De Faire U, Helmers C, Miah K, Ryding C, Wester PO. Arrhythmias in patients with acute cerebrovascular disease. Acta Med Scand 1979; 205(5): 425-8.
6. Dziewierz A, Siudak Z, Rakowski T, Zasada W, Krzanowska K, Dudek D. The ACEF (age, creatinine, ejection fraction) score predicts ischemic and bleeding outcomes of patients with acute coronary syndromes treated conservatively. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej 2017; 13(2): 160-4.
7. Ranucci M, Castelvecchio S, Menicanti L, Frigiola A, Pelissero G. Risk of assessing mortality risk in elective cardiac operations: age, creatinine, ejection fraction, and the law of parsimony. Circulation 2009; 119 (24): 3053–61.
8. Silver FL, Norris JW, Lewis AJ, Hachinski VC. Early mortality following stroke: a prospective review. Stroke 1984; 15(3): 492–6.
9. Adams RJ, Chimowitz MI, Alpert JS, Awad IA, Cerqueria MD, Fayad P et al. Coronary risk evaluation in patients with transient ischemic attack and ischemic stroke: a scientific statement for healthcare professionals from the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/Am Stroke Association. Stroke 2003; 34(9): 2310–22.
10. Cheung RTF, Hachinski VC. The insula and cerebrogenic sudden death. Archives of Neurology 2000; 57(12): 1685–8.
11. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Circulation 1996; 93(5): 1043–106.
12. Goldstein LB, Adams R, Alberts MJ, Appel LJ, Brass LM, Bushnell CD et al. Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: the American Academy of Neurology affirms the value of this guideline. Stroke 2006; 37(6): 1583-633.
13. Brown RD, Whisnant JP, Sicks JD, O'Fallon WM, Wiebers DO. Stroke incidence, prevalence, and survival: secular trends in Rochester, Minnesota, through 1989. Stroke 1996; 27(3): 373-80.
14. Di Carlo A, Lamassa M, Baldereschi M, Pracucci G, Basile AM, Wolfe CD et al. Sex differences in the clinical presentation, resource use, and3-month outcome of acute stroke in Europe: data froma multicenter multinational hospital-based registry. Stroke 2003; 34(5): 1114-9.
15. Kapral MK, Fang J, Hill MD, Silver F, Richards J, Jaigobin C et al. Sex differences instroke care and outcomes: results from the Registry ofthe Canadian Stroke Network. Stroke 2005; 36(4): 809-14.
16. Gibson CL. Cerebral ischemic stroke: is gender important? J Cereb Blood Flow Metab 2013; 33(9): 1355-61.
17. Sacco RL, Benjamin EJ, Broderick JP. American Heart Association Prevention Conference IV. Prevention and rehabilitation of stroke Risk factors. Stroke 1997; 28(7): 1507-17.
18. Reindl M, Reinstadler SJ, Tiller C, Kofler M, Theurl M, Klier N et al. ACEF score adapted to ST-elevation myocardial infarction patients: the ACEF-STEMI score. International journal of cardiology 2018; 264(1): 18-24.
19. Capodanno D, Ministeri M, Dipasqua F, Dalessandro V, Cumbo S, Gargiulo G et al. Risk prediction of contrast-induced nephropathy by ACEF score in patients undergoing coronary catheterization. Journal of Cardiovascular Medicine 2016; 17(7): 524-9.
20. Wykrzykowska JJ, Garg S, Onuma Y, De Vries T, Goedhart D, Morel MA et al. Value of age, creatinine, and ejection fraction (ACEF score) in assessing risk in patients undergoing percutaneous coronary interventions in the ‘all-comers' leaders trial. Circulation Cardiovascular Interventions 2011; 4(1): 47-56.
21. Kistler PM, Sanders P, Fynn SP, Stevenson IH, Spence SJ, Vohra JK et al. Electrophysiologic and electroanatomic changes in the human atrium associated with age. J Am Coll Cardiol 2004; 44(1): 109–16.
22. Preston CC, Oberlin AS, Holmuhamedov EL, Gupta A, Sagar S, Syed RHK et al. Aging-induced alterations in gene transcripts and functional activity of mitochondrial oxidative phosphorylation complexes in the heart. Mech Ageing Dev 2008; 129(6): 304–12.
23. Mirza M, Strunets A, Shen WK, Jahangir A. Mechanisms of arrhythmias and conduction disorders in older adults. Clinics in geriatric medicine 2012; 28(4): 555-73.
24. Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. 2011 accf/aha/ hrs focused updates incorporated into the acc/aha/esc 2006 guidelines for the management of patients with atrial fibrillation: A report of the american college of cardiology foundation/american heart association task force on practice guidelines. Circulation 2011; 123(10): e269–367.
25. Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Abhayaratna WP et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation 2006; 114(2): 119-25.
26. Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol 2006; 48(5): e247–346.
27. Kiuchi MG, Ho JK, Nolde JM, Gavidia LML, Carnagarin R, Matthews VB et al. Sympathetic activation in hypertensive chronic kidney disease–a stimulus for cardiac arrhythmias and sudden cardiac death? Frontiers in physiology 2020; 10(1): 1546.
28. Di Pasquale G, Andreoli A, Grazi P, Dominici P, Pinelli G. Cardioembolic stroke from atrial septal aneurysm. Stroke 1988; 19(5): 640-3.
29. Dusleag J, Klein W, Eber B, Gasser R, Brussee H, Rotman B et al. Frequency of magnetic resonance signal abnormalities of the brain in patients aged less than 50 years with idiopathic dilated cardiomyopathy. Am J Cardiol 1992; 69(17): 1446-50.