Stroke risk analysis (synonyms: SRA analysis; stroke risk analyzer; stroke risk analysis) is a novel procedure in the field of apoplectic insult (stroke) prevention. It is a diagnostic procedure that allows early detection of the risk of stroke in patients at risk based on the ECG (electrocardiogram; procedure that creates the electrical record of heart activity). The focus is on the detection of the so-called paroxysmal atrial fibrillation (transient (paroxysmal) cardiac arrhythmia with disordered activity of the atria), which is a significant risk factor for apoplectic insult. The following text deals with the technique of SRA analysis and the theoretical background. A stroke (also cerebral stroke; synonyms: cerebral insult, apoplexia cerebri, apoplectic insult, in medical colloquial language often abbreviated to apoplex or insult) is an acute circulatory disturbance or intracerebral hemorrhage (ICB; cerebral hemorrhage). In this case, ischemia (tissue death/cell death) occurs due to the lack of oxygen resulting from the lack of blood supply. Stroke leads to death in about 20% of cases. The main causes of this clinical picture are:
- Arterio-arterial embolism – occlusion of a cerebral artery by a blood clot or starting from arteriosclerotic changes in the vessels.
- Cardiac embolism – occlusion of a cerebral artery by a blood clot originating in the heart.
- Dissection of an arterial vessel – rupture of the inner vessel wall with hemorrhage into the middle vessel wall.
- Vessel rupture – rupture of a vessel.
The aforementioned atrial fibrillation is the main cause of cardiac embolism. The aim of SRA analysis is to detect atrial fibrillation in time, so that a stroke can be prevented preventively. The uncontrolled movements of the heart muscle in atrial fibrillation change the dynamics of blood flow. As a result, the blood comes to a standstill in some areas, which promotes blood clotting and thus the formation of an embolus. The embolus can break loose and travel through the carotids (carotid artery) directly into the cerebral arteries (brain vessels), causing an insult. Until now, the diagnosis of this clinical picture was only possible with the help of the so-called long-term ECG. This involves recording the patient’s electrocardiogram for 24 hours. Only if atrial fibrillation occurs during the recording period can it be diagnosed by a physician, as it only becomes visible then. For this reason, the probability of capturing the said moment is very low in many patients and the diagnosis often cannot be made.
Indications (areas of application)
- Overweight (obesity) – if the body mass index (BMI) is greater than 27, SRA analysis should be performed.
- Diabetes mellitus (diabetes)
- Heart failure (cardiac insufficiency)
- Hypertension (high blood pressure)
- Coronary heart disease (CHD) – coronary artery disease.
- Sleep apnea (SAS) – symptoms caused by cessation of breathing (apnea) during sleep.
- Condition after apoplexy (stroke).
The procedure
SRA analysis is a solution to this problem. For the analysis, the patient’s normal ECG is derived for about one hour. Using a novel mathematical method, the data are modified to determine if atrial fibrillation has occurred in the past. This method does not rely on atrial fibrillation actually occurring during the study period. The so-called nonlinear mathematical methods compute time values from the ECG and classify the data into risk groups following a decision pathway:
- Sinus rhythm (normal heart rhythm).
- Atrial arrhythmias (cardiac arrhythmias in the atrial region).
- Check for paroxysmal atrial fibrillation required.
- Other cardiac arrhythmias
- Significant evidence of paroxysmal atrial fibrillation
- Significant signs of acute atrial fibrillation
Benefit
Stroke risk analysis is an innovative procedure that reveals a previously elusive risk factor for stroke. Thus, patients at risk for stroke can be better identified and given preventive therapy.Patients at risk include not only elderly patients with the above risk factors, but also young athletic people and competitive athletes. SRA analysis paves the way for effective early detection and thus a reduction in stroke rates.
