open access

Vol 52, No 2 (2018)
Original research articles
Submitted: 2016-09-28
Get Citation

The importance of atrial fibrillation and selected echocardiographic parameters for the effectiveness and safety of thrombolytic therapy in patients with stroke

Anetta Lasek-Bal, Teresa Kowalewska-Twardela, Aldona Warsz-Wianecka, Przemysław Puz, Aleksandra Krzan, Aleksandra Cieślik
DOI: 10.1016/j.pjnns.2017.09.001
·
Neurol Neurochir Pol 2018;52(2):156-161.

open access

Vol 52, No 2 (2018)
Original research articles
Submitted: 2016-09-28

Abstract

Background

The efficacy and safety of thrombolytic therapy in stroke depend on multiple factors. The aim of this study was to evaluate the significance of atrial fibrillation the prognosis in terms of the functional status in patients with stroke treated with intravenous thrombolysis. An additional aim was also to assess the potential significance of reduced ejection fraction (EF) and enlarged left atrium (LA) of the heart for the prognosis in patients with stroke who underwent thrombolytic therapy.

Methodology

A prospective study involved enrollment of 222 patients, mean age of 72 years with first-in-life ischemic stroke. In all participants there were realized procedures as follows: neurological status before administering rt-PA (NIHSS), selected echocardiographic parameters, functional status on the 14th day from the onset (mRankin scale) and analysis the bleeding events.

Results

Atrial fibrillation was significantly more frequent in women than men; females had higher CHA2DS2VASc scores and heavier neurological conditions on day 1 of stroke. Two independent factors for poor prognosis (3–5 points by mRankin) were found: the NIHSS score and the CHA2DS2VASc score ≥3. We identified 2 independent factors for death within 14 days from the onset: the result by NIHSS and the EF. The NIHSS score turned out to be the only independent predictor of hemorrhage during hospitalization: RR 1.19; CI [1.06–1.33]; p=0.003; p for model=0.0025.

Conclusions

The presence of atrial fibrillation worsens the patient's prognosis in terms of the functional status and survival during the acute period of stroke in patients treated with intravenous thrombolysis.

Higher NIHSS and CHA2DS2VASc scores and reduced EF in patients with stroke treated with thrombolysis are the predictors of unfavorable short-term prognosis.

Abstract

Background

The efficacy and safety of thrombolytic therapy in stroke depend on multiple factors. The aim of this study was to evaluate the significance of atrial fibrillation the prognosis in terms of the functional status in patients with stroke treated with intravenous thrombolysis. An additional aim was also to assess the potential significance of reduced ejection fraction (EF) and enlarged left atrium (LA) of the heart for the prognosis in patients with stroke who underwent thrombolytic therapy.

Methodology

A prospective study involved enrollment of 222 patients, mean age of 72 years with first-in-life ischemic stroke. In all participants there were realized procedures as follows: neurological status before administering rt-PA (NIHSS), selected echocardiographic parameters, functional status on the 14th day from the onset (mRankin scale) and analysis the bleeding events.

Results

Atrial fibrillation was significantly more frequent in women than men; females had higher CHA2DS2VASc scores and heavier neurological conditions on day 1 of stroke. Two independent factors for poor prognosis (3–5 points by mRankin) were found: the NIHSS score and the CHA2DS2VASc score ≥3. We identified 2 independent factors for death within 14 days from the onset: the result by NIHSS and the EF. The NIHSS score turned out to be the only independent predictor of hemorrhage during hospitalization: RR 1.19; CI [1.06–1.33]; p=0.003; p for model=0.0025.

Conclusions

The presence of atrial fibrillation worsens the patient's prognosis in terms of the functional status and survival during the acute period of stroke in patients treated with intravenous thrombolysis.

Higher NIHSS and CHA2DS2VASc scores and reduced EF in patients with stroke treated with thrombolysis are the predictors of unfavorable short-term prognosis.

Get Citation

Keywords

Stroke, Thrombolysis, Atrial fibrillation, Echocardiography

About this article
Title

The importance of atrial fibrillation and selected echocardiographic parameters for the effectiveness and safety of thrombolytic therapy in patients with stroke

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 52, No 2 (2018)

Pages

156-161

DOI

10.1016/j.pjnns.2017.09.001

Bibliographic record

Neurol Neurochir Pol 2018;52(2):156-161.

Keywords

Stroke
Thrombolysis
Atrial fibrillation
Echocardiography

Authors

Anetta Lasek-Bal
Teresa Kowalewska-Twardela
Aldona Warsz-Wianecka
Przemysław Puz
Aleksandra Krzan
Aleksandra Cieślik

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl