Abstract
Background: Cryptogenic stroke (CS) represents 25% of ischemic strokes. Especially after CS, the detection of atrial fibrillation (AF) is important because it provides clues to the mechanism of stroke. However, the relationship between AF and stroke appears more complex than a simple cause-effect mechanism, suggesting that the association between AF and stroke may be due to other systemic and atrial factors including systemic inflammation that may lead to atrial remodeling and subsequent atrial cardiopathy.
Objective: The aim of this study was to evaluate the relationship among different electrocardiographic parameters, inflammatory markers and in-hospital AF occurrence after acute CS. Methods: 222 patients with CS underwent 12-lead resting ECG at admission and 7-day in-hospital ECG monitoring. The following indices were evaluated: P-wave dispersion (PWD), P-wave index, P-wave axis, atrial size and high-sensitivity-C reactive protein (CRP). Results: AF was detected in 44 patients. AF-group had significantly higher PWD, P-wave index, PR interval, CRP and greater frequency of abnormal P-wave axis in comparison with no-AF group. There was a significant correlation between CRP and PWD (r=0.28). By using the mediation analysis, performed according to the “bootstrapping” method, we found that PWD is a significant mediator variable of the relationship between CRP and AF occurrence, accounting for 40% of the association. Conclusions: In cryptogenic stroke, high PWD is partly due to systemic inflammation that increases AF risk possibly via atrial electric remodeling. These findings could also suggest inflammation as a possible therapeutic target in order to prevent atrial electrical alterations and finally AF occurrence in CS.Keywords: Ischemic stroke, cryptogenic stroke, atrial fibrillation, inflammation, C reactive protein, P wave dispersion, electrocardiogram, atrial cardiopathy.
Graphical Abstract
[2]
Thijs, V. Atrial fibrillation detection - fishing for an irregular heartbeat before and after stroke. Stroke, 2017, 48, 2671-2677.
[3]
Acampa, M.; Lazzerini, P.E.; Martini, G. How to identify patients at risk of silent atrial fibrillation after cryptogenic stroke: potential role of p wave dispersion. J. Stroke, 2017, 19(2), 239-241.
[4]
Acampa, M.; Lazzerini, P.E.; Martini, G. Letter by Acampa et al regarding article, Underutilization of ambulatory ECG monitoring after stroke and transient ischemic attack: Missed opportunities for atrial fibrillation detection. Stroke, 2016, 47e277
[5]
Acampa, M.; Lazzerini, P.E.; Martini, G. Atrial cardiopathy and sympatho-vagal imbalance in cryptogenic stroke: Pathogenic mechanisms and effects on ECG markers. Front. Neurol., 2018, 19(9), 469.
[6]
Acampa, M.; Guideri, F.; Tassi, R.; Dello Buono, D.; Celli, L.; di Toro Mammarella, L.; Lazzerini, P.E.; Marotta, G.; Lo Giudice, G.; D’Andrea, P.; Martini, G. P wave dispersion in cryptogenic stroke: a risk factor for cardioembolism? Int. J. Cardiol., 2015, 190, 202-204.
[7]
Acampa, M.; Lazzerini, P.E.; Guideri, F.; Tassi, R.; Andreini, I.; Domenichelli, C.; Cartocci, A.; Martini, G. Electrocardiographic predictors of silent atrial fibrillation in cryptogenic stroke. Heart Lung Circ, 2018.Nov 16. pii: S1443-9506(18)31965-6..
[http://dx.doi.org/10.1016/j.hlc.2018.10.020]
[http://dx.doi.org/10.1016/j.hlc.2018.10.020]
[8]
Acampa, M.; Lazzerini, P.E.; Guideri, F.; Tassi, R.; Lo Monaco, A.; Martini, G. Inflammation and atrial electrical remodeling in
patients with embolic strokes of undetermined source. Heart Lung
Circ., 2018.May 8. pii: S1443-9506(18)30465-7..
[http://dx.doi.org/10.1016/j.hlc.2018.04.294]
[http://dx.doi.org/10.1016/j.hlc.2018.04.294]
[9]
Adams, H.P., Jr; Bendixen, B.H.; Kappelle, L.J.; Biller, J.; Love, B.B.; Gordon, D.L.; Marsh, E.E. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke, 1993, 24, 35-41.
[10]
Acampa, M.; Lazzerini, P.E.; Guideri, F.; Tassi, R.; Lo Monaco, A.; Martini, G. Previous use of statins and atrial electrical remodeling in patients with cryptogenic stroke. Cardiovasc. Hematol. Disord. Drug Targets, 2017, 17(3), 212-215.
[11]
Boos, C.J.; Anderson, R.A.; Lip, G.Y.H. Is atrial fibrillation an inflammatory disorder? Eur. Heart J., 2006, 27(2), 136-149.
[12]
Hu, Y.F.; Chen, Y.J.; Lin, Y.J.; Chen, S.A. Inflammation and the pathogenesis of atrial fibrillation. Nat. Rev. Cardiol., 2015, 12, 230-243.
[13]
Lazzerini, P.E.; Capecchi, P.L.; Laghi Pasini, F. Systemic inflammation and arrhythmic risk: lessons from rheumatoid arthritis. Eur. Heart J., 2017, 38, 1717-1727.
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