无症状性心房颤动检测设备的研究进展

无症状性心房颤动(房颤)约占房颤人群的1/3,可能具有更高的卒中风险。早期发现无症状性房颤对减少房颤导致的卒中十分重要。随着技术的发展,用于房颤筛查的检测设备层出不穷。各种检测设备各具特点,不同检测设备对房颤筛查的选择十分重要。人工智能对房颤的识别使其成了房颤筛查的研究热点。现对无症状性房颤检测设备现况和进展进行综述,并探讨其在无症状性房颤筛查、卒中预防和管理中的应用价值与发展空间。     

隐匿性心房颤动筛查的研究进展

隐匿性心房颤动(房颤)是指无典型临床症状、无确切房颤病史,但可通过心电监测技术检出的房颤。隐匿性房颤占总体房颤的15%～40%,对隐匿性房颤患者进行筛查、确诊和治疗,可有效降低致残率和致死率,显著降低医疗成本,节约医疗资源。该文主要介绍隐匿性房颤筛查的重点人群、筛查策略及筛查方式。     

机器学习在心房颤动筛查和管理中的应用进展

心房颤动是一种常见的心律失常类型,随着年龄增长其发病率不断升高,且其不规则的心脏节律会引起急性脑卒中等严重并发症。但心房颤动发作时多无明显症状,患者常在发生栓塞事件后才会被首次确诊。近年来随着人工智能技术不断发展,机器学习可以帮助临床医生识别心房颤动高危人群。本文主要综述了机器学习在心房颤动筛查和管理中的应用进展,旨在提高临床医生对机器学习的认识。     

大连市社区老年人群无症状房颤筛查：一项单中心研究

目的探究大连市社区老年人群无症状房颤的患病率, 分析不同的筛查方案在该人群中的检出率。方法本研究为前瞻性队列研究。选取大连市社区自愿参加免费体检的≥65岁老年人。将参与体检人群随机分为筛查组(包括强化筛查组和1次筛查组)及对照组。对照组接受问诊、病史采集及常规12导联心电图检查, 筛查组除上述内容外额外佩戴单导联动态心电设备, 佩戴时间为5～7 d, 强化筛查组在2020和2021年接受2次同等时长的佩戴, 1次筛查组仅在2020年接受1次佩戴。结果最终共纳入3 340人, 年龄(70.7±5.0)岁, 其中男性1 488例(44.55%)。筛查组1 945人, 其中强化筛查组859人, 1次筛查组1 086人。对照组纳入1 395人。对照组和筛查组房颤检出率分别为24例(1.72%)、79例(4.06%), 筛查组房颤检出率高于对照组(P<0.001)。根据合并房颤危险因素的个数不同分组, 在合并1个或2～3个危险因素亚组中, 筛查组检出率均高于对照组, CHA2DS2-VASc评分2～3分及≥4分亚组中, 筛查组检出率均高于对照组(P均<0.05)。强化筛查组及1次筛查...     

心血管疾病高危人群的早期筛查模型

心血管疾病是一个重大的公共卫生问题。目前有多种心血管病高危人群早期筛查模型,例如Framingham、China-PAR、SCORE和QRISK模型等。本文对目前一些心血管病高危人群筛查模型作一综述。     

糖尿病高危人群的筛查结果分析

目的 描述糖尿病高危人群的血糖筛查结果数据,分析影响高危人群中糖尿病及糖调节受损的危险因素.方法 收集2017年1月—2020年1月于该院检查的98例糖尿病高危人群的基本信息、体格检查数据及血糖检测数据等进行统计分析,采用Logistic回归分析影响糖尿病及血糖调节受损的因素.结果 98例糖尿病高危人;群中共检出糖尿病...     

三种评分方法在缺血性卒中合并心房颤动筛查中的应用

目的探讨心房颤动筛查评分(STAF)和包括左心房直径(L)、年龄(A)、卒中/短暂性脑缺血发作(D)、发病前1年吸烟(S)4个指标的LADS评分以及包括年龄、美国国立卫生研究院卒中量表(NIHSS)评分、左心房扩大及血管病因4个指标的ASAS评分3种方法在缺血性卒中合并心房颤动患者筛查中的临床应用价值。方法回顾性分析2016年4月至2017年4月于广州医科大学附属第二医院神经内科住院的急性缺血性卒中患者317例的临床及影像学资料,依据患者是否合并心房颤动分为房颤组(56例)和非房颤组(261例),收集患者的性别、年龄、既往史、NIHSS评分、超声心动图结果及脑血管评估情况等相关临床资料,对所有患者分别进行STAF、LADS和ASAS评分,绘制受试者工作特征曲线(ROC),计算曲线下面积并比较3种方法预测缺血性卒中合并心房颤动发生的敏感度、特异度以及准确度。结果房颤组与非房颤组患者比较,年龄[(69±11)岁比(62±12)岁]、NIHSS评分[(8.2±1.3)分比(4.4±0.3)分]、左心房内径[(42.3±6.8)mm比(31.7±2.5)mm]差异均有统计学意义(t值分别为2.99、3.38、6.32,均P0.01)。STAF评分诊断缺血性卒中合并心房颤动的曲线下面积为0.801,最佳截断点为STAF≥5分,敏感度为58.9%,特异度81.2%,准确度77.3%;LADS评分诊断缺血性卒中合并心房颤动的曲线下面积为0.846,最佳截断点为LADS≥4分,敏感度66.1%,特异度83.5%,准确度80.4%;ASAS预测值评分诊断缺血性卒中合并心房颤动的曲线下面积为0.835,最佳截断点为ASAS预测值≥0.09分,敏感度85.7%,特异度56.7%,准确度61.8%;3种评分方法敏感度、特异度及准确度差异均有统计学意义(χ2值分别为10.308、59.685、32.054,均P0.01)。结论 LADS≥4分在筛选急性缺血性卒中合并心房颤动中的准确度最高。     

心房颤动负荷的研究进展

心房颤动(房颤)是常见的心律失常之一, 如何早期识别并跟踪房颤进展是降低房颤相关不良事件的重要手段。近年来将"心房颤动负荷(房颤负荷)"用于评估房颤进展, 本文就房颤负荷的定义、监测、与临床事件的关系, 房颤负荷在临床管理中的应用进展及将来的研究方向进行综述。     

亚洲城市与农村心房颤动人群筛查与管理现状

心房颤动（房颤）是最常见的心律失常,可导致卒中、心力衰竭、痴呆及死亡等严重并发症。由于部分房颤呈间歇性发作,且无相关症状,因此容易被漏诊并耽误治疗。近年来长程和远程心电监测设备的出现和发展,促进了房颤筛查工作,并得到一些较大规模研究证实。本文综述了基于亚洲人群的房颤筛查研究结果、目前筛查技术以及未来的研究方向。     

超声内镜在胰腺癌筛查中的作用

胰腺癌是一种病死率极高、预后极差的恶性肿瘤,为实现胰腺癌的早期诊断和及时干预,选取合适的技术手段在高危人群中进行针对性的胰腺癌筛查意义重大.近年来超声内镜(EUS)技术发展迅速,较高的诊断率及EUS-FNA等新技术的进步使其在胰腺癌筛查中表现出显著优势,但仍需要高质量的临床研究加以证实.未来,EUS联合新型分子标志物检...     

心房颤动药物治疗研究新进展

心房颤动（arial fibrillation,AF）简称房颤,是最常见的持续性心律失常之一。房颤发病率较高,平均为0．15％-1％,随年龄的增加而升高,60岁患者发病率达3．8％,80岁患者可高达9．0％。Heeringa研究发现,55岁以上的男性房颤患者死亡率约23．8％,女性约为22．2％,且与患者本身的心脏疾病有密切关系。Schumacher等研究表明,房颤合并快速心室率可使心输出量减少30％,其中15％是由于心房失去泵功能所致,15％是由心室律不齐所致。     

无症状性房颤心电图筛查与诊断的研究进展

房颤是一种常见病,随着心血管危险因素的增加和人口老龄化进程,房颤在世界范围内的发病率正在上升.房颤患者发生缺血性卒中、心力衰竭、死亡和认知能力下降的风险增加;约1/3的房颤因无症状或隐匿而未能被及时发现和治疗.口服抗凝剂治疗可降低房颤患者发生缺血性卒中的风险和死亡率,因此,尽早筛查出无症状性房颤并早期确诊,对正规使用口服抗凝剂和预防缺血性卒中至关重要.目前,房颤的早期识别和治疗指南较少.本文综述了房颤心电检测、筛查和诊断方法方面的最新研究进展.     

Advancement in antithrombotics for stroke prevention in atrial fibrillation

The focus of this review is the evolving field of antithrombotic drug therapy for stroke prevention in patients with atrial fibrillation (AF). The current standard of therapy includes warfarin, acenocoumarol and phenprocoumon which have proven efficacy by reducing stroke by 68% against placebo. However, a narrow therapeutic index, wide variation in metabolism, and numerous food and drug interactions have limited their clinical application to only 50% of the indicated population. Newer agents such as direct thrombin inhibitors, factor Xa inhibitors, factor IX inhibitors, tissue factor inhibitors and a novel vitamin K antagonist are being developed to overcome the limitations of current agents. The direct thrombin inhibitor dabigatran is farthest along in development. Further clinical trial testing, and eventual incorporation into clinical practice will depend on safety, efficacy and cost. Development of a novel vitamin K antagonist with better INR control will challenge the newer mechanistic agents in their quest to replace the existing vitamin K antagonists. Till then, the large unfilled gap to replace conventional agents remains open. This review will assess all these agents, and compare their mechanism of action, stage of development and pharmacologic profile.     

持续性心房颤动患者无症状心房颤动的发生情况及影响因素

Objective To investigate the incidence of asymptomatic atrial fibrillation( AF) and the influence factors in patients with persistent AF. Methods A total of 82 consecutive patients with 24 h Holter monitoring identified persistent AF were observed to analyze the incidence of asymptomatic AF. 24 h Holter monitoring was performed again after three months' treatment with antiarrythmic drugs in order to identify the incidence of asymptomatic AF. Multivariate logistic regression was applied for analyzing the correlation between symptoms and clinical features. Results Thirty-four patients(42% )were asymptomatic ,24 patients were symptomatic. After antiarrythmic drugs therapy for three months, 31 patients among 48 symptomatic patients, were completely asymptomatic, 4 were converted to sinus rhythm, 27 were asymptomatic atrial fibrillation. In 34 asymptomatic patients, 5 were converted to sinus rhythm, 24 remain asymptomatic atrial fibrillation. Significant differences were found between symptomatic and asymptomatic patients with persistent AF between age and valvular heart disease( P ＜ 0. 05 ). Symptoms were positively with valvular heart disease (b = 1. 959, P = 0. 001 ),and negatively with age( b = -0. 837,P = 0. 032). Conclusion The incidence of asymptomatic persistent AF was high. Antiarrythmic drugs could not only relieve the episodes of AF, but also the symptoms of AF. Elderly and nonvalvular atrial fibrillation(NVAF) patients were often asymptomatic.     

持续性心房颤动患者无症状心房颤动的发生情况及影响因素

Objective To investigate the incidence of asymptomatic atrial fibrillation( AF) and the influence factors in patients with persistent AF. Methods A total of 82 consecutive patients with 24 h Holter monitoring identified persistent AF were observed to analyze the incidence of asymptomatic AF. 24 h Holter monitoring was performed again after three months' treatment with antiarrythmic drugs in order to identify the incidence of asymptomatic AF. Multivariate logistic regression was applied for analyzing the correlation between symptoms and clinical features. Results Thirty-four patients(42% )were asymptomatic ,24 patients were symptomatic. After antiarrythmic drugs therapy for three months, 31 patients among 48 symptomatic patients, were completely asymptomatic, 4 were converted to sinus rhythm, 27 were asymptomatic atrial fibrillation. In 34 asymptomatic patients, 5 were converted to sinus rhythm, 24 remain asymptomatic atrial fibrillation. Significant differences were found between symptomatic and asymptomatic patients with persistent AF between age and valvular heart disease( P ＜ 0. 05 ). Symptoms were positively with valvular heart disease (b = 1. 959, P = 0. 001 ),and negatively with age( b = -0. 837,P = 0. 032). Conclusion The incidence of asymptomatic persistent AF was high. Antiarrythmic drugs could not only relieve the episodes of AF, but also the symptoms of AF. Elderly and nonvalvular atrial fibrillation(NVAF) patients were often asymptomatic.     

持续性心房颤动患者无症状心房颤动的发生情况及影响因素

目的 分析持续性心房颤动(房颤)患者中无症状房颤的发生情况及影响因素.方法 收集经24 h动态心电图监测确诊的持续性房颤患者82例,观察症状的有无及发生比例.经抗心律失常药物治疗3个月后复查24 h动态心电图监测,观察症状的变化情况.采用多无logistic回归分析持续性房颤症状与临床特征的相关性.结果 82例患者中34例(42%)无症状房颤发作,48例有症状房颤发作.应用抗心律失常药物治疗3个月后,48例有症状患者中31例症状完全消失,其中4例转复为窦性心律,27例为无症状房颤发作.34例无症状患者中,5例转复为窦性心律,24例仍为无症状房颤发作.持续性房颤中有症状和无症状患者年龄,瓣膜病比较差异有统计学意义(P＜0.05).其症状与瓣膜病呈正相关(b=1.959,P=0.001),与年龄呈负相关(b=-0.837,P=0.032).结论 持续性房颤患者中无症状房颤的发生率较高.抗心律失常药物既可减少房颤发作,又可减少房颤症状.高龄和非瓣膜病房颤患者易发生无症状房颤.     

无症状阵发性心房颤动的临床特点分析

目的探讨无症状阵发性心房颤动的发作规律及临床特点,寻找筛查无症状阵发性心房颤动的方法。方法收集确诊为阵发性心房颤动的患者134例,根据动态心电图及临床资料,分为无症状组55例和症状组79例。分析2组24h平均心室率、P波离散度、临床特征等的差异,并进行多元logistic回归分析。结果 2组P波离散度比较差异无统计学意义(P>0.05)。无症状组男性比例明显多于女性(P<0.01),24 h平均心室率及心房颤动发作时的平均心室率明显低于症状组(P<0.01)。无症状组服用β受体阻滞剂的比例及夜间发作心房颤动次数明显高于症状组[65.5%vs 40.5%,(20.18±4.85)次vs(3.27±1.74)次,P<0.05,P<0.01]。多元logistic回归分析,男性、夜间阵发性心房颤动、服用β受体阻滞剂、24h平均心室率、阵发性心房颤动时最快心室率和平均窦性心率患者更易发生无症状阵发性心房颤动(P<0.05)。结论男性、夜间心房颤动、服用β受体阻滞剂及平均心室率较慢的患者发作心房颤动时,表现为无症状,动态心电图可以作为高危人群的筛查手段。