THE RELATIONSHIP BETWEEN ATRIAL FIBRILLATION AND ISCHEMIC STROKE, GENDER AND AGE DIFFERENCES

Abstract

The purpose of this study was to study the gender and age characteristics of the relationship between cardioembolic ischemic stroke (CEIS) and AF for risk stratification, screening and further secondary prevention of recurrent strokes.

Materials and methods. Total of 46 patients with acute ischemic stroke were examined. Detailed analysis was conducted on clinical, neurological, instrumental, laboratory and anamnestic data. Statistical analysis was performed using Excel, applying Chi-square and Fisher's Exact Tests with a significance threshold of p < 0.05 to investigate the relationship between stroke history, atrial fibrillation (AF) and other factors. The risk of recurrent stroke in patients with AF was assessed using the CHADS2-VASc score.

Results. The analysis revealed a significant association between atrial fibrillation (AF) and a history of stroke overall (χ² = 33.495, p < 0.05). Fisher's Exact Test, used due to small sample sizes and low expected frequencies, confirmed a strong association with a p-value of 0.001. For men, the test yielded a p-value of  0.0476, while for women, it was 0.0009, indicating a strong correlation in both genders, particularly pronounced in women where all stroke cases were linked to AF. The odds ratios were infinite, reflecting a very high correlation. Age-stratified analysis showed significant associations only in the 70-79 age group (p = 0.005), with no significant results in younger age groups.

             This study underscores a strong association between atrial fibrillation (AF) and a history of stroke, with significant findings for both men and women. The data highlights a particularly strong correlation in women, where all stroke cases were associated with AF. The results also indicate that this association is notably significant in the 70-79 age group. These findings emphasize the critical role of AF as a risk factor for stroke, reinforcing the need for targeted screening and management strategies for patients with AF, especially in older populations. Additionally, a comprehensive evaluation using the CHADS2-VASc score is essential for assessing the risk of stroke in patients with AF. This involves considering various forms of AF (e.g., paroksizmal, persistent or permanent) and differentiating between those with and without significant internal or external branching. Implementing a thorough core monitoring approach is crucial for accurate prediction and effective management of stroke risk in these patients. Future research with larger sample sizes is needed to explore underlying mechanisms and validate these findings across diverse populations.

            According to the results obtained, it is necessary to assess the risk of CEIS on the CH2ADS2-VASc scale in all patients with atrial fibrillation of various forms both with and without developing stroke and a thorough cardiological examination, in order to predict the risk and secondary prevention of CEIS. These studies should include ECG, transthoracic ECHO-CG, MRI of  the brain (for patients with ACA) and duplex scanning of the brachiocephalic arteries. These studies are the basis for the choice of secondary prevention of CEIS, which includes a wide range of promising areas, including endovascular occlusion of the open foramen ovale (Pristipino C, 2019), high-intensity lipid-lowering therapy (Giugliano R, 2020), the use of intensive antiplatelet, combined antithrombotic and anticoagulant therapy (Johnston S, 2020; Sharma M, 2019), heart rhythm control and arrhythmia treatment with modern endovascular methods[4].

Keywords: acute cerebrovascular accident (ONMC), atrial fibrillation, cardioembolic subtype of ischemic stroke (CEI)