Preliminary Analysis Of The P-wave Indices In Offspring Of Stroke Patients With Atrial Fibrillation

Part 1 Study on the relationship between P-wave related Indices and the risk of atrial fibrillation in offspring of stroke patients with atrial fibrillationBackground and objectiveAtrial fibrillation(AF)is a common arrhythmia in clinic and one of the most common risk factors of stroke.The results showed that parental AF was an independent predictor of offspring AF(odds ratio(OR)1.85).When both parents had AF,the child’s OR value of AF was 3.2,suggesting that parental AF was a risk factor for AF in offspring.If a first-degree relative is diagnosed with AF,the child’s risk of AF increases by about 40 per cent.Although the genetic characteristics of nonvalvular atrial fibrillation(NVAF)have been established,the laboratory indicators for effectively predicting the occurrence of AF in children are not well studied at home and abroad.A large number of previous studies have reported that ECG related P-wave indices(including P-wave duration,P-wave dispersion,P-wave terminal force in V1 and PR interval)and atrial related serum markers(including BNP,hs-CRP and D-dimer)have shown superiority in AF prediction,and valuable in risk assessment and stratification of stroke occurrence as well.Therefore,this data analyzed the changes of ECG-related p-wave indices and atrial related serum markers in the children of NVAF stroke patients,and compared them with similar indices in the children of non-embolic cerebral infarction patients,hoping to obtain valuable enlightenment.Since this topic mainly involves NVAF patients and their children,valvular AF patients are excluded.AF in the following paragraphs refers to NVAF patients in particular.MethodFrom January 2018 to January 2019,the children of ischemic stroke patients with Nonvalvular atrial fibrillation,(NVAF)were prospectively recruited in the anticoagulation clinic,cardiology department,neurology clinic or ward of Yangzhou University affiliated Hospital,or in the open recruitment as the experimental group.At the same time,the children whose patients were diagnosed as ischemic stroke and had no history of atrial fibrillation in the Department of Neurology of our hospital were selected as the control group.The demographic and vascular risk factors of the experimental group and the control group were matched,and there was no significant difference between the two groups.The data of demography,vascular risk factors,family history,routine electrocardiogram and serum markers were collected.The ECG related P-wave indices and atrial myopathy related serum indexes were compared between the two groups.ResultThe total number of patients included in this study was 242,there were 135 males(55.78%)and 107 females(44.22%),with an average age of 49.19±9.56 years.There were 122 cases in the experimental group and 120 cases in the control group.Statistical analysis of the relevant P-wave indicators in the two groups showed that there were significant differences between the observation group and the control group in Pmax(114.43±10.58ms vs 105.82±11.29ms),Pd(30.11±10.80ms vs 20.33±8.96ms)and PTFV1(22.29±7.07mm.ms vs 16.14±6.72mm.ms)(P<0.001).Multivariate logistic regression analysis showed that BMI(OR1.211,95%CI1.088-1.348;P<0.001)was independently correlated with Pmax>110ms.Age(OR1.088,95%CI1.019～1.162;P=0.012)was independently associated with Pd≥40ms.In addition,hs-CRP,BNP and D-dimer were examined in 42 cases in the experimental group and 32 cases in the control group,but there was no significant difference(P>0.05).ConclusionThe offspring of stroke patients with NVAF have significant differences in Pmax,Pd and PTFV1 with the children of atherosclerotic cerebral infarction patients.This difference comes from AF itself or stroke,and needs to be compared with the children of AF patients without embolism events.Part 2 Correlation between P-wave dispersion parameters and paroxysmal atrial fibrillation in patients with ischemic strokeBackground and objectiveAtrial fibrillation(AF)is one of the most important independent risk factors for ischemic stroke.Studies have shown that the stroke risk of paroxysmal atrial fibrillation(PAF)is basically similar to that of persistent AF,and the stroke risk of paroxysmal atrial fibrillation is five times higher than that of patients without AF.Because of the short onset of PAF,patients usually do not have obvious clinical symptoms,so the diagnosis of PAF in patients with acute ischemic stroke has become a challenge.A large number of previous studies have shown that prolonged ECG monitoring has been shown to be beneficial to ischemic stroke patients with some potential PAF,but it is time-consuming and cumbersome and has poor patient compliance.Therefore.the diagnosis of PAF in patients with ischemic stroke is still a difficult problem.A large number of studies have shown that P-wave dispersion parameters(including maximum P-wave duration(Pmax),minimum P-wave duration(Pmin),P-wave dispersion(Pd))are good ECG indices for predicting PAF.It has got the researchers’ attention.The purpose of this study was to investigate the correlation between P-wave dispersion parameters and PAF in patients with acute ischemic stroke.MethodThe incidence of PAF in patients with acute ischemic stroke was analyzed retrospectively.All patients were admitted to the Department of Neurology,affiliated Hospital of Yangzhou University from September 2016 to September 2018 within 24 hours after stroke and completed routine 12-lead electrocardiogram.During the 7 days of hospitalization,24-hour dynamic electrocardiogram monitoring and color Doppler echocardiography(Philips iE33 diagnostic instrument)were completed.Patients were divided into PAF group and non-PAF group according to the presence or absence of PAF.Data on demographics,vascular risk factors,stroke characteristics,hematological examination,P-wave dispersion parameters,and color Doppler echocardiography were collected for all patients who met the inclusion and exclusion criteria.It mainly includes gender,age,body mass index,hypertension,diabetes mellitus,hyperlipidemia,obesity,smoking,drinking,previous stroke history,P-wave dispersion parameters,left atrial diameter and so on.Pmax,Pmin and PD in routine electrocardiogram were recorded,and multivariate logistic regression analysis was used to determine the independent correlation between different P-wave dispersion parameters and PAF in patients with acute ischemic stroke after adjusting for confounding factors.Result140 cases were accord with the inclusion and exclusion criteria.After 24-hour dynamic ECG monitoring and screening,PAF was detected in 21 patients(15%)during hospitalization.There were 83 males and 57 females,with an average age of(70.51±7.98)years,78 cases of hypertension,55 cases of diabetes mellitus,35 cases of hyperlipidemia,32 cases of smoking and 20 cases of drinking.There were significant differences in age,baseline NIHSS score,BNP,Pmax,Pd and left atrial diameter between PAF patients and patients without PAF(P<0.05).After adjusting for all variables(P<0.1)(including age,baseline NIHSS score,BNP,Pmax,Pd,left atrial diameter)in univariate analysis,Multivariate logistic regression analysis showed that Pd(OR1.193,95%CI 1.044～1.324;P=0.00]),baseline NIHSS score(ORI.59,95%CI1.166～2.189;P=0.004)is an independent risk factor for PAF in patients with ischemic stroke.ConclusionPd and baseline NIHSS score were independently correlated with PAF in patients with acute ischemic stroke.Further detection of PAF,and timely anticoagulant therapy in patients with increased Pd,high baseline NIHSS score are helpful to reduce the risk of stroke recurrence.