S. A. Chazov, S. Mekhryakov, A. Kulesh, L. Syromyatnikova, P. Astanin
{"title":"隐源性栓塞性中风患者的心房心肌病:发病率、工具性诊断特征、对预后的影响","authors":"S. A. Chazov, S. Mekhryakov, A. Kulesh, L. Syromyatnikova, P. Astanin","doi":"10.14412/2074-2711-2023-6-40-47","DOIUrl":null,"url":null,"abstract":"Latent atrial fibrillation (AF), whose substrate is atrial cardiomyopathy (AC), is considered the main potential pathogenetic mechanism of cryptogenic embolic stroke (CES). Early detection of AC allows to intensify the search for AF in such patients.Objective: to compare the characteristics of patients with CES in terms of clinical and anamnestic data, echocardiographic parameters, MRI patterns of infarction foci and disease outcomes depending on the presence of the major markers for AC.Material and methods. We studied 103 patients in the acute phase of CES with a lesion confirmed by MRI data, who were divided into two groups according to the presence (n=17) or absence (n=86) of AC. A comprehensive clinical, laboratory, and instrumental examination was performed and long-term outcomes were assessed. The median follow-up period was 32 months.Results. The incidence of AC in the CES population was 17%; the most common markers were an increase in left atrial volume index and paroxysms of supraventricular tachycardia. Patients with AC-CES were characterised by older age and a two-fold increase in the prevalence of coronary heart disease. Patients with AC-CES were nine times more likely to have a \"black artery\" symptom on MRI than patients without AC. The predictive accuracy of this clinical pattern was 84%, the sensitivity was 60% and the specificity was 86%. Patients with AC-CES had a significantly higher risk (odds ratio 3.4; 95% confidence interval 1.1–9.9; p=0.023) for a composite outcome that included the development of recurrent ischemic stroke, transient ischemic attack, myocardial infarction or death.Conclusion. AC diagnosed by a combination of echocardiographic and electrocardiographic signs is present in 17% of patients with CES. Patients with AC-CES are characterised by elderly age, the presence of atherosclerosis-associated disease, a specific MRI pattern (the “black artery” symptom) and an unfavourable prognosis during the 2.5-year follow-up period.","PeriodicalId":19252,"journal":{"name":"Neurology, neuropsychiatry, Psychosomatics","volume":"73 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2023-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Atrial cardiomyopathy in patients with cryptogenic embolic stroke: incidence, instrumental diagnostic features, impact on prognosis\",\"authors\":\"S. A. Chazov, S. Mekhryakov, A. Kulesh, L. Syromyatnikova, P. Astanin\",\"doi\":\"10.14412/2074-2711-2023-6-40-47\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Latent atrial fibrillation (AF), whose substrate is atrial cardiomyopathy (AC), is considered the main potential pathogenetic mechanism of cryptogenic embolic stroke (CES). Early detection of AC allows to intensify the search for AF in such patients.Objective: to compare the characteristics of patients with CES in terms of clinical and anamnestic data, echocardiographic parameters, MRI patterns of infarction foci and disease outcomes depending on the presence of the major markers for AC.Material and methods. We studied 103 patients in the acute phase of CES with a lesion confirmed by MRI data, who were divided into two groups according to the presence (n=17) or absence (n=86) of AC. A comprehensive clinical, laboratory, and instrumental examination was performed and long-term outcomes were assessed. The median follow-up period was 32 months.Results. The incidence of AC in the CES population was 17%; the most common markers were an increase in left atrial volume index and paroxysms of supraventricular tachycardia. Patients with AC-CES were characterised by older age and a two-fold increase in the prevalence of coronary heart disease. Patients with AC-CES were nine times more likely to have a \\\"black artery\\\" symptom on MRI than patients without AC. The predictive accuracy of this clinical pattern was 84%, the sensitivity was 60% and the specificity was 86%. Patients with AC-CES had a significantly higher risk (odds ratio 3.4; 95% confidence interval 1.1–9.9; p=0.023) for a composite outcome that included the development of recurrent ischemic stroke, transient ischemic attack, myocardial infarction or death.Conclusion. AC diagnosed by a combination of echocardiographic and electrocardiographic signs is present in 17% of patients with CES. Patients with AC-CES are characterised by elderly age, the presence of atherosclerosis-associated disease, a specific MRI pattern (the “black artery” symptom) and an unfavourable prognosis during the 2.5-year follow-up period.\",\"PeriodicalId\":19252,\"journal\":{\"name\":\"Neurology, neuropsychiatry, Psychosomatics\",\"volume\":\"73 1\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-12-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neurology, neuropsychiatry, Psychosomatics\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.14412/2074-2711-2023-6-40-47\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurology, neuropsychiatry, Psychosomatics","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.14412/2074-2711-2023-6-40-47","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
潜伏性心房颤动(AF)的基底是心房心肌病(AC),被认为是隐源性栓塞性中风(CES)的主要潜在致病机制。目的:比较隐源性栓塞性中风(CES)患者在临床和病理数据、超声心动图参数、梗塞灶的磁共振成像模式以及疾病预后方面的特征,具体取决于是否存在隐源性栓塞性中风的主要标志物。我们研究了 103 例经核磁共振成像数据证实有病变的 CES 急性期患者,根据是否存在 AC 分成两组(17 例)。我们对患者进行了全面的临床、实验室和仪器检查,并评估了长期疗效。中位随访期为 32 个月。CES人群中AC的发生率为17%;最常见的标志是左心房容积指数增加和室上性心动过速阵发性发作。AC-CES患者的特点是年龄较大,冠心病发病率增加了两倍。AC-CES 患者在核磁共振成像中出现 "黑色动脉 "症状的几率是无 AC 患者的九倍。这种临床模式的预测准确率为84%,灵敏度为60%,特异性为86%。AC-CES患者发生复发性缺血性中风、短暂性脑缺血发作、心肌梗死或死亡等综合结果的风险明显更高(几率比3.4;95%置信区间1.1-9.9;P=0.023)。综合超声心动图和心电图征象诊断出的AC在17%的CES患者中存在。AC-CES患者的特点是高龄、存在动脉粥样硬化相关疾病、特殊的磁共振成像模式("黑色动脉 "症状)以及在2.5年的随访期间预后不良。
Atrial cardiomyopathy in patients with cryptogenic embolic stroke: incidence, instrumental diagnostic features, impact on prognosis
Latent atrial fibrillation (AF), whose substrate is atrial cardiomyopathy (AC), is considered the main potential pathogenetic mechanism of cryptogenic embolic stroke (CES). Early detection of AC allows to intensify the search for AF in such patients.Objective: to compare the characteristics of patients with CES in terms of clinical and anamnestic data, echocardiographic parameters, MRI patterns of infarction foci and disease outcomes depending on the presence of the major markers for AC.Material and methods. We studied 103 patients in the acute phase of CES with a lesion confirmed by MRI data, who were divided into two groups according to the presence (n=17) or absence (n=86) of AC. A comprehensive clinical, laboratory, and instrumental examination was performed and long-term outcomes were assessed. The median follow-up period was 32 months.Results. The incidence of AC in the CES population was 17%; the most common markers were an increase in left atrial volume index and paroxysms of supraventricular tachycardia. Patients with AC-CES were characterised by older age and a two-fold increase in the prevalence of coronary heart disease. Patients with AC-CES were nine times more likely to have a "black artery" symptom on MRI than patients without AC. The predictive accuracy of this clinical pattern was 84%, the sensitivity was 60% and the specificity was 86%. Patients with AC-CES had a significantly higher risk (odds ratio 3.4; 95% confidence interval 1.1–9.9; p=0.023) for a composite outcome that included the development of recurrent ischemic stroke, transient ischemic attack, myocardial infarction or death.Conclusion. AC diagnosed by a combination of echocardiographic and electrocardiographic signs is present in 17% of patients with CES. Patients with AC-CES are characterised by elderly age, the presence of atherosclerosis-associated disease, a specific MRI pattern (the “black artery” symptom) and an unfavourable prognosis during the 2.5-year follow-up period.