Significance of cerebral microinfarcts in antiphospholipid syndrome: A population-based study.

IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY
Jonathan Naftali, Rani Barnea, Ruth Eliahou, Walid Saliba, Sivan Bloch, Michael Findler, Ran Brauner, Tzippy Shochat, Avi Leader, Eitan Auriel
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引用次数: 0

Abstract

Background: Acute ischemic stroke (AIS) or transient ischemic attack (TIA) is the most common neurological manifestations of patients with antiphospholipid syndrome (APS). Incidental diffusion-weighted imaging (DWI) positive subcortical and cortical lesions, or acute incidental cerebral microinfarcts (CMI), are microscopic ischemic lesions, detectable on MRI for 10-14 days only. We aimed to look at the prevalence of acute incidental CMI in a cohort of patients with APS and their association with subsequent AIS or TIA.

Methods: This is a population-based cohort study of adults with APS diagnosis using International Statistical Classification-9 (ICD-9) and supporting laboratory results between January 2014 and April 2020. We included any patient undergoing brain MRI (index event) during the year prior APS diagnosis or at any time point following diagnosis. Age-matched subjects with negative APS laboratory workup were used as a control group. In the first analysis, we compared acute incidental CMI prevalence in both groups. We then performed a second analysis among APS patients only, comparing patients with and without acute incidental CMI for AIS or TIA as the primary outcome. Cox proportional hazards models used to calculate hazards ratio (HR) and 4 years cumulative risk.

Results: 292 patients were included, of which, 207 patients with APS. Thirteen patients with APS had acute incidental CMI on MRI (6.3%), compared with none in the control group (p = 0.013). Following multivariable analysis, APS was the sole factor associated with acute incidental CMI (p = 0.026). During a median follow-up of 4 years (IQR 3.5, 4) in patients with APS, following multivariable analysis, acute incidental CMI was associated with subsequent AIS or TIA (HR 6.73 [(95% CI, 1.96-23.11], p < 0.01).

Conclusion: Acute incidental CMI are more common among patients with APS than in patients with negative APS tests, and are associated with subsequent AIS or TIA. Detecting acute incidental CMI in patients with APS may guide etiological workup and reevaluation of antithrombotic regimen.

抗磷脂综合征中脑微梗塞的重要性
背景:急性缺血性卒中(AIS)或短暂性脑缺血发作(TIA)是抗磷脂综合征(APS)患者最常见的神经系统表现。偶然出现的弥散加权成像(DWI)阳性皮质下和皮质病变或急性偶然性脑微梗死(CMI)是微小的缺血性病变,只能在 10-14 天内通过核磁共振成像检测到。我们的目的是研究 APS 患者队列中急性偶发 CMI 的发病率及其与后续 AIS 或 TIA 的关联:这是一项基于人群的队列研究,研究对象是在 2014 年 1 月 1 日至 2020 年 4 月 4 日期间使用国际统计分类-9(ICD-9)诊断出 APS 并提供实验室结果支持的成年人。我们纳入了所有在 APS 诊断前一年或诊断后任何时间点接受脑磁共振成像(指数事件)检查的患者。年龄匹配、APS 实验室检查结果为阴性的患者作为对照组。在第一项分析中,我们比较了两组中急性偶发性 CMI 的发病率。然后,我们仅在 APS 患者中进行了第二项分析,以 AIS 或 TIA 为主要结果,比较了有急性偶发 CMI 和没有急性偶发 CMI 的患者。结果:共纳入 292 例患者,其中 207 例为 APS 患者。13名APS患者在磁共振成像中出现急性偶发性CMI(6.3%),而对照组中没有(P=0.013)。经过多变量分析,APS是与急性偶发CMI相关的唯一因素(P=0.026)。在对 APS 患者进行中位随访 4 年(IQR 3.5,4)期间,经过多变量分析,急性偶发 CMI 与随后的 AIS 或 TIA 相关(HR-6.73[(95% CI 1.96-23.11],p 结论:急性偶发 CMI 在 APS 患者中比在 APS 检测阴性的患者中更为常见,并且与随后的 AIS 或 TIA 相关。在 APS 患者中发现急性偶发 CMI 可为病因检查和重新评估抗血栓治疗方案提供指导。
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来源期刊
International Journal of Stroke
International Journal of Stroke 医学-外周血管病
CiteScore
13.90
自引率
6.00%
发文量
132
审稿时长
6-12 weeks
期刊介绍: The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.
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