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Article: Risk of ischemic stroke after new-onset atrial fibrillation in patients with hyperthyroidism

TitleRisk of ischemic stroke after new-onset atrial fibrillation in patients with hyperthyroidism
Authors
KeywordsAtrial fibrillation
Hyperthyroidism
Ischemic stroke
Issue Date2009
PublisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/heartrhythmjournal
Citation
Heart Rhythm, 2009, v. 6 n. 2, p. 169-173 How to Cite?
AbstractBackground: Hyperthyroidism is one of the most common reversible causes of atrial fibrillation (AF); nevertheless, the risk of ischemic stroke in patients with hyperthyroidism who present with new-onset AF is unclear. Objective: This study sought to investigate the clinical outcome of hyperthyroidism-induced AF with regard to risk of ischemic stroke risk. Methods: We prospectively studied the incidence, time course, and clinical predictors for ischemic stroke in patients with hyperthyroidism-induced AF (n = 160). They were compared with age- and sex-matched cohorts of hyperthyroid patients without AF (n = 160) and AF patients without hyperthyroidism (n = 160). Results: Baseline characteristics were comparable among the 3 groups. At 1 year, 86 hyperthyroid patients with AF (54%) and 92 patients with nonthyroid AF (58%) had spontaneous or pharmacological sinus conversion (P = .20). Ischemic stroke was observed in 15 hyperthyroid patients with AF (9.4%) versus 5 patients with nonthyroid AF (3.1%, P = .02), and 1 hyperthyroid patient without AF (0.6%, P < .001). Furthermore, the majority of ischemic stroke (>70%) in patients with AF occurred within the first 30 days of presentation, whereas AF was still present. Cox regression analysis showed that hyperthyroidism (hazard ratio [HR]: 3.5, 95% confidence interval [CI]: 1.15 to 10.42, P = .03) and persistent AF (HR: 13.0, 95% CI: 2.88 to 58.80, P < .01) predicted the occurrence of ischemic stroke; warfarin therapy reduced the risk of ischemic stroke (HR: 0.17, 95% CI: 0.04 to 0.79, P = .02). Conclusion: In hyperthyroid patients who presented with new-onset AF, there was an increased risk of ischemic stroke clustering during the initial phase of presentation. This should prompt early use of anticoagulation therapy in hyperthyroid patients with AF. © 2009 Heart Rhythm Society.
Persistent Identifierhttp://hdl.handle.net/10722/92559
ISSN
2015 Impact Factor: 4.391
2015 SCImago Journal Rankings: 2.756
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorSiu, CWen_HK
dc.contributor.authorPong, Ven_HK
dc.contributor.authorZhang, Xen_HK
dc.contributor.authorChan, YHen_HK
dc.contributor.authorJim, MHen_HK
dc.contributor.authorLiu, Sen_HK
dc.contributor.authorYiu, KHen_HK
dc.contributor.authorKung, AWCen_HK
dc.contributor.authorLau, CPen_HK
dc.contributor.authorTse, HFen_HK
dc.date.accessioned2010-09-17T10:50:05Z-
dc.date.available2010-09-17T10:50:05Z-
dc.date.issued2009en_HK
dc.identifier.citationHeart Rhythm, 2009, v. 6 n. 2, p. 169-173en_HK
dc.identifier.issn1547-5271en_HK
dc.identifier.urihttp://hdl.handle.net/10722/92559-
dc.description.abstractBackground: Hyperthyroidism is one of the most common reversible causes of atrial fibrillation (AF); nevertheless, the risk of ischemic stroke in patients with hyperthyroidism who present with new-onset AF is unclear. Objective: This study sought to investigate the clinical outcome of hyperthyroidism-induced AF with regard to risk of ischemic stroke risk. Methods: We prospectively studied the incidence, time course, and clinical predictors for ischemic stroke in patients with hyperthyroidism-induced AF (n = 160). They were compared with age- and sex-matched cohorts of hyperthyroid patients without AF (n = 160) and AF patients without hyperthyroidism (n = 160). Results: Baseline characteristics were comparable among the 3 groups. At 1 year, 86 hyperthyroid patients with AF (54%) and 92 patients with nonthyroid AF (58%) had spontaneous or pharmacological sinus conversion (P = .20). Ischemic stroke was observed in 15 hyperthyroid patients with AF (9.4%) versus 5 patients with nonthyroid AF (3.1%, P = .02), and 1 hyperthyroid patient without AF (0.6%, P < .001). Furthermore, the majority of ischemic stroke (>70%) in patients with AF occurred within the first 30 days of presentation, whereas AF was still present. Cox regression analysis showed that hyperthyroidism (hazard ratio [HR]: 3.5, 95% confidence interval [CI]: 1.15 to 10.42, P = .03) and persistent AF (HR: 13.0, 95% CI: 2.88 to 58.80, P < .01) predicted the occurrence of ischemic stroke; warfarin therapy reduced the risk of ischemic stroke (HR: 0.17, 95% CI: 0.04 to 0.79, P = .02). Conclusion: In hyperthyroid patients who presented with new-onset AF, there was an increased risk of ischemic stroke clustering during the initial phase of presentation. This should prompt early use of anticoagulation therapy in hyperthyroid patients with AF. © 2009 Heart Rhythm Society.en_HK
dc.languageengen_HK
dc.publisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/heartrhythmjournalen_HK
dc.relation.ispartofHeart Rhythmen_HK
dc.subjectAtrial fibrillationen_HK
dc.subjectHyperthyroidismen_HK
dc.subjectIschemic strokeen_HK
dc.subject.meshAdulten_HK
dc.subject.meshAtrial Fibrillation - complicationsen_HK
dc.subject.meshBrain Ischemia - epidemiology - etiologyen_HK
dc.subject.meshCase-Control Studiesen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshHumansen_HK
dc.subject.meshHyperthyroidism - complicationsen_HK
dc.subject.meshIncidenceen_HK
dc.subject.meshMaleen_HK
dc.subject.meshMiddle Ageden_HK
dc.subject.meshProportional Hazards Modelsen_HK
dc.subject.meshProspective Studiesen_HK
dc.subject.meshRisken_HK
dc.titleRisk of ischemic stroke after new-onset atrial fibrillation in patients with hyperthyroidismen_HK
dc.typeArticleen_HK
dc.identifier.emailSiu, CW:cwdsiu@hkucc.hku.hken_HK
dc.identifier.emailChan, YH:chanwill@hku.hken_HK
dc.identifier.emailLiu, S:shasha.vivi@gmail.comen_HK
dc.identifier.emailYiu, KH:khkyiu@hku.hken_HK
dc.identifier.emailKung, AWC:awckung@hku.hken_HK
dc.identifier.emailTse, HF:hftse@hkucc.hku.hken_HK
dc.identifier.authoritySiu, CW=rp00534en_HK
dc.identifier.authorityChan, YH=rp01313en_HK
dc.identifier.authorityLiu, S=rp01628en_HK
dc.identifier.authorityYiu, KH=rp01490en_HK
dc.identifier.authorityKung, AWC=rp00368en_HK
dc.identifier.authorityTse, HF=rp00428en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.hrthm.2008.10.023en_HK
dc.identifier.pmid19187905-
dc.identifier.scopuseid_2-s2.0-59149092293en_HK
dc.identifier.hkuros153473-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-59149092293&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume6en_HK
dc.identifier.issue2en_HK
dc.identifier.spage169en_HK
dc.identifier.epage173en_HK
dc.identifier.isiWOS:000263147800004-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridSiu, CW=7006550690en_HK
dc.identifier.scopusauthoridPong, V=26025247300en_HK
dc.identifier.scopusauthoridZhang, X=16425051500en_HK
dc.identifier.scopusauthoridChan, YH=22633700600en_HK
dc.identifier.scopusauthoridJim, MH=6603860344en_HK
dc.identifier.scopusauthoridLiu, S=16424616100en_HK
dc.identifier.scopusauthoridYiu, KH=35172267800en_HK
dc.identifier.scopusauthoridKung, AWC=7102322339en_HK
dc.identifier.scopusauthoridLau, CP=35275317200en_HK
dc.identifier.scopusauthoridTse, HF=7006070805en_HK

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