Circulation:各类房颤筛查方法的综合对比

2020-05-23 QQY MedSci原创

卒中(中风)是一个日益严重的全球性健康问题。房颤(AF)是卒中的一个主要风险因素,随着新的监测技术的开发,当下越来越重视对AF的筛查。本研究旨在评估一个大规模筛查策略的表现,评估与确诊相关的人群特征。

卒中(中风)是一个日益严重的全球性健康问题。房颤(AF)是卒中的一个主要风险因素,随着新的监测技术的开发,当下越来越重视对AF的筛查。本研究旨在评估一个大规模筛查策略的表现,评估与确诊相关的人群特征。

从普通人群中招募有卒中风险因素但无AF的个体,用植入式循环记录器进行筛查。持续≥6min的新发AF由资深心脏病专家判定。在连续监测>3年后,为每个受试者重建完整的日常心率数据集,包括所有AF发作和终止的确切时间。采用随机抽样的方法对不同模拟筛查策略的筛查敏感性和阴性预测值进行评估,并与植入式循环记录仪进行比较。

心率数据集包含590位受试者,共持续观测659 758天,共记录了20 110次AF发作。在这些数据中,单次持续10秒的心电图(ECG)检查发现AF的敏感性(阴性预测价值)仅1.5%(66%),连续14天,每天进行两次持续30秒的ECG发现AF的敏感性(阴性预测价值)增加至8.3%(67%),24小时、48小时、72小时、7天或30天持续监测的敏感性(阴性预测价值)分别增加至11% (68%)、13% (68%)、15% (69%)、21% (70%)和34% (74%) 。而且,重复进行监测可进一步提高AF的检测(如3次24小时监测 vs 1次72小时监测)。在年龄≥75岁、男性、CHADS2评分>2或NT-proBNP≥40 pmol/L和AF发作持续超过24小时的受试者中,AF检出的敏感性始终较高。

在有卒中危险因素的受试者中筛查AF,诊断率随时间、弥散度和筛查次数的增加而增加,尽管所有策略的诊断率都低于植入式循环记录器。年龄较大、男性或NT-proBNP较高的受试者的敏感性较高。

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    2020-08-27 14818eb4m67暂无昵称

    👍

    0

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    2020-05-24 心介

    房颤,临床上碰到很多哦

    0

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    2020-05-24 一天没事干

    很好的学习机会

    0

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