PURPOSE: To study the relationship between hypertension, atrial fibrillation (AF), LVH, left atrial enlargement (LAE), and nonhemorrhagic stroke (NHS).
METHODS: 673 patients admitted from 1/1/05 to 12/31/06 with stroke and CT showing cerebral artery occlusion without hemorrhage were reviewed.
RESULTS: Hypertension was diagnosed in 542 patients (80.53%), AF in 169 (25.15%). Hypertension was present in 148 of patients with AF (87.6%) and AF in 148 (27.3%) with hypertension and in 21 (16.0%) of nonhypertensive patients (p<0.01). Among the 169 AF pts, AF was intermittent in 65 (38.5%) and 55 had ECGs without AF on the day of admission (32.5%). Echocardiograms were randomly reviewed in 64 pts with chronic AF (CAF), 53 with intermittent AF (IAF), and 53 without AF (NAF); all reviewed pts had hypertension. LV systolic dysfunction (ejection fraction <50%) occurred in 16 CAF (25%), 14 IAF (26.4%) and 8 NAF pts (15.1%). All pts with systolic dysfunction had left atria >4.0 cm (LAE). LAE was present in 45/48 (93.8%) CAF pts with normal EjFx (>50%) (NEF), in 22/39 (56.4%) IAF pts with NEF, and in 20/45 (44.4%) NAF pts with NEF. LVH was present in 51/64 (79.7%) CAF, in 37/53 (69.8%) IAF and in 34/53 (64.2%) NAF pts; 41/48 (85.4%) with CAF and NEF had LVH, 27/37 (69.2%) IAF pts with NEF had LVH, and 32/45 (71.1%) NAF pts with NEF had LVH.
CONCLUSION: AF is commonly diagnosed (25.15%) in nonhemorrhagic stroke; most of these pts have hypertension (87.6%). AF was intermittent in 38.5%. LAE and LVH with normal EjFx are common in hypertensive pts with NHS (suggesting diastolic dysfunction). The similarity in incidence of LVH and LAE in hypertensive pts with intermittent AF and with no AF suggests that diastolic dysfunction is common in these pts and undiscovered intermittent AF may be the culprit in most stroke patients with hypertension rather than thrombosis in situ.
CLINICAL IMPLICATIONS: Intermittent AF should be looked for in all pts with hypertension, especially those with LVH and LAE on echo; anticoagulation to prevent stroke should be considered in these pts.
DISCLOSURE: Jacob Haft, None.