心房颤动卒中预防指南解读.ppt

The prevalence of AF in the adult population doubles with each advancing decade of age from 0.5% at age 50-59 years to 9% at age 80-89 years (Fig. l). As aging proceeds there is gradual loss of nodal fibers and increase of fibrous and adipose tissue in the s韓o-atrial node (2). Decreased ventricular compliance occurs due to myocardial fibrosis resulting in atrial dilatation that has been shown to predispose to AF (3). Extensive senile amyloid infiltration of the sinoatrial node may occur (4). However, aging also 韓volves longer exposure to predisposing conditions, and even in advanced age some are clearly more vulnerable to the development of AF than others. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Wolf PA, Abbott RD, Kannel WB. Department of Neurology, Evans Memorial Department of Clinical Research, Boston, Mass. The impact of nonrheumatic atrial fibrillation, hypertension, coronary heart disease, and cardiac failure on stroke incidence was examined in 5,070 participants in the Framingham Study after 34 years of follow-up. Compared with subjects free of these conditions, the age-adjusted incidence of stroke was more than doubled in the presence of coronary heart disease (p less than 0.001) and more than trebled in the presence of hypertension (p less than 0.001). There was a more than fourfold excess of stroke in subjects with cardiac failure (p less than 0.001) and a near fivefold excess when atrial fibrillation was present (p less than 0.001). In persons with coronary heart disease or cardiac failure, atrial fibrillation doubled the stroke risk in men and trebled the risk in women. With increasing age the effects of hypertension, coronary heart disease, and cardiac failure on the risk of stroke became progressively weaker (p less than 0.05). Advancing age, however, did not reduce the significant impact of atrial fibrillation. For persons aged 80-89 years, atrial fibrillation was the sole cardiovascular condition to exert