Importância do holter na avaliação de pacientes com acidente vascular cerebral isquêmico
Carregando...
Data
2022-10-27
Autores
Trivellato, Stella De Angelis
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: O Acidente Vascular Cerebral (AVC) isquêmico é a principal causa de incapacidade a longo prazo e a segunda causa de morte no mundo. Pode ser dividido etiologicamente em cinco tipos de acordo com a classificação TOAST, sendo um deles o AVC cardioembólico que tem a fibrilação atrial (FA) como principal desencadeador. O Holter 24 horas deve ser realizado quando há suspeita de arritmia e para AVC sem causa determinada; sua adequada investigação e caracterização podem auxiliar no manejo clínico e na prevenção de novos eventos. A FA eleva o risco de recorrência de AVC e geralmente as taxas de detecção se correlacionam com a duração do monitoramento cardíaco. Objetivos: Avaliar se o percentual de pacientes com AVC de etiologia indeterminada de acordo com a classificação TOAST diminui após realização do Holter 24horas e verificar a capacidade preditiva das variáveis do Holter 24 horas no prognóstico após AVC isquêmico. Casuística e Métodos: Trata-se de um estudo observacional e retrospectivo, no qual foram realizadas avaliações clínica, neurológica, ecocardiográfica e Holter 24 horas de pacientes internados com diagnóstico de AVC isquêmico na Unidade de AVC do Hospital das Clínicas da Faculdade de Medicina de Botucatu (HC-FMB-UNESP). A capacidade funcional foi avaliada na alta hospitalar e após 90 dias. Foram utilizados modelos de regressão linear múltipla e regressão logística múltipla ajustados pelos fatores confundidores. O nível de significância foi de p<0,05. Resultados: Foram incluídos 1587 pacientes, sendo 89,8% da raça branca e 56,7% do sexo masculino, com média de 69 anos de idade. O exame de Holter 24 horas foi realizado em 483 (30,4%) pacientes, sendo identificado ritmo de FA em 64 pacientes, correspondendo a 13,3%, sendo que 20,3% daqueles que realizaram o exame desconheciam o histórico de arritmia cardíaca. Pacientes submetidos ao Holter 24 horas tiveram chance 83% maior de serem classificados como TOAST indeterminado (OR=1,83; IC95%:1,44-2,32; p<0,001). Pacientes submetidos a trombólise, bem como aqueles que realizaram ecocardiograma, tiveram menor associação com Rankin ≥ 4 na alta hospitalar. Conclusões: A realização do Holter 24 horas durante internação por AVC isquêmico não reduz a Resumo 3 possibilidade de TOAST indeterminado. Em relação à capacidade preditiva dos dados clínicos sobre o prognóstico dos pacientes com AVC isquêmico, há benefício da trombólise e do ecocardiograma no mRS e no NIHSS, e a realização do Holter 24 horas mostra impacto positivo no NIHSS.
Background: Ischemic stroke is the leading cause of long-term disability and the second leading cause of death worldwide. It can be etiologically divided into five types according to the TOAST classification, one of which is cardioembolic stroke that has atrial fibrillation (AF) as the main trigger. The 24-hour Holter should be performed when there is a suspicion of arrhythmia and for stroke without a specific cause; its proper investigation and characterization can help in the clinical management and in the prevention of new events. AF increases the risk of stroke recurrence, and detection rates generally correlate with the duration of cardiac monitoring. Objectives: To assess whether the percentage of patients with stroke of undetermined etiology according to the TOAST classification decreases after performing 24-hour Holter and to verify the predictive capacity of 24-hour Holter variables in the prognosis after ischemic stroke. Methods: This is an observational and retrospective study, in which clinical, neurological, echocardiographic and 24- hour Holter assessments were performed in patients hospitalized with a diagnosis of ischemic stroke at the Stroke Unit of Hospital das Clínicas, Faculdade de Medicina de Botucatu (HC-FMB-UNESP). Functional capacity was assessed at hospital discharge and after 90 days. Multiple linear regression and multiple logistic regression models adjusted for confounding factors were used. The significance level was p<0.05. Results: A total of 1587 patients were included, 89.8% white and 56.7% male, with a mean age of 69 years. The 24-hour Holter exam was performed in 483 (30.4%) patients, and AF rhythm was identified in 64 patients, corresponding to 13.3%, and 20.3% of those who underwent the exam were unaware of the history of arrhythmia heart. Patients undergoing 24-hour Holter had an 83% greater chance of being classified as indeterminate TOAST (OR=1.83; 95% CI: 1.44-2.32; p<0.001). Patients undergoing thrombolysis, as well as those undergoing echocardiography, had a lower association with Rankin ≥ 4 at hospital discharge. Conclusions: Performing 24-hour Holter during hospitalization for ischemic stroke does not reduce the possibility of indeterminate TOAST. Regarding the predictive capacity of clinical data on the prognosis of patients with ischemic stroke, there is a benefit of thrombolysis and echocardiography in the mRS and NIHSS, and the performance of 24-hour Holter shows a positive impact on the NIHSS.
Background: Ischemic stroke is the leading cause of long-term disability and the second leading cause of death worldwide. It can be etiologically divided into five types according to the TOAST classification, one of which is cardioembolic stroke that has atrial fibrillation (AF) as the main trigger. The 24-hour Holter should be performed when there is a suspicion of arrhythmia and for stroke without a specific cause; its proper investigation and characterization can help in the clinical management and in the prevention of new events. AF increases the risk of stroke recurrence, and detection rates generally correlate with the duration of cardiac monitoring. Objectives: To assess whether the percentage of patients with stroke of undetermined etiology according to the TOAST classification decreases after performing 24-hour Holter and to verify the predictive capacity of 24-hour Holter variables in the prognosis after ischemic stroke. Methods: This is an observational and retrospective study, in which clinical, neurological, echocardiographic and 24- hour Holter assessments were performed in patients hospitalized with a diagnosis of ischemic stroke at the Stroke Unit of Hospital das Clínicas, Faculdade de Medicina de Botucatu (HC-FMB-UNESP). Functional capacity was assessed at hospital discharge and after 90 days. Multiple linear regression and multiple logistic regression models adjusted for confounding factors were used. The significance level was p<0.05. Results: A total of 1587 patients were included, 89.8% white and 56.7% male, with a mean age of 69 years. The 24-hour Holter exam was performed in 483 (30.4%) patients, and AF rhythm was identified in 64 patients, corresponding to 13.3%, and 20.3% of those who underwent the exam were unaware of the history of arrhythmia heart. Patients undergoing 24-hour Holter had an 83% greater chance of being classified as indeterminate TOAST (OR=1.83; 95% CI: 1.44-2.32; p<0.001). Patients undergoing thrombolysis, as well as those undergoing echocardiography, had a lower association with Rankin ≥ 4 at hospital discharge. Conclusions: Performing 24-hour Holter during hospitalization for ischemic stroke does not reduce the possibility of indeterminate TOAST. Regarding the predictive capacity of clinical data on the prognosis of patients with ischemic stroke, there is a benefit of thrombolysis and echocardiography in the mRS and NIHSS, and the performance of 24-hour Holter shows a positive impact on the NIHSS.
Descrição
Palavras-chave
Acidente vascular cerebral, Fibrilação atrial, Holter, Cardioembolismo, TOAST, Stroke, Atrial fibrillation, , Cardioembolism,