癌症中风患者右左分流的发病率。

IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY
International Journal of Stroke Pub Date : 2024-10-01 Epub Date: 2024-06-13 DOI:10.1177/17474930241260589
Fabienne Steinauer, Philipp Bücke, Eric Buffle, Mattia Branca, Jayan Göcmen, Babak B Navi, Ava L Liberman, Anna Boronylo, Leander Clenin, Martina Goeldlin, Julian Lippert, Bastian Volbers, Thomas R Meinel, David Seiffge, Adnan Mujanovic, Johannes Kaesmacher, Urs Fischer, Marcel Arnold, Thomas Pabst, Martin D Berger, Simon Jung, Morin Beyeler
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引用次数: 0

摘要

背景和目的:癌症与急性缺血性脑卒中(AIS)和静脉血栓栓塞风险增加有关。心脏右左分流(RLS)作为矛盾性栓塞的替代指标在癌症相关中风中的作用尚不确定。我们试图研究 AIS 患者出现 RLS 与癌症之间的关系:我们纳入了 2015 年 1 月至 2020 年 12 月期间在我们的三级卒中中心住院的连续 AIS 患者,这些患者经食道超声心动图(TEE)检测出 RLS 状态。对活动性癌症进行了回顾性鉴别,并通过多变量逻辑回归和逆治疗概率加权评估了与RLS的关系,以尽量减少经食道超声心动图检查的确定偏倚:在纳入的 2236 名 AIS 患者中,103 人(4.6%)患有活动性癌症,其中 24 人(23%)被诊断为 RLS。在2133名无活动性癌症的AIS患者中,有774人(36%)患有RLS。经过调整和加权后,无 RLS 与癌症活动有关(调整后的几率比 [aOR],2.29;95% 置信区间 [CI],1.14-4.58)。当分析对象仅限于年龄小于60岁或RLS风险较高的患者(并发栓塞风险评分≥6分)时,RLS与癌症之间没有关联(aOR,3.07;95% CI,0.79-11.88;aOR,0.56;95% CI,0.10-3.10):结论:与未患癌症的患者相比,AIS 癌症患者被诊断出 RLS 的频率较低,这表明动脉源在癌症相关中风中的作用可能大于矛盾性静脉栓塞。未来的研究需要验证这些发现,并评估潜在的治疗意义,如在这一患者群体中关闭 PFO 的一般适应症或缺乏适应症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prevalence of right-to-left shunt in stroke patients with cancer.

Background and objectives: Cancer is associated with an increased risk of acute ischemic stroke (AIS) and venous thromboembolism. The role of a cardiac right-to-left shunt (RLS) as a surrogate parameter for paradoxical embolism in cancer-related strokes is uncertain. We sought to investigate the relationship between the presence of an RLS and cancer in AIS patients.

Methods: We included consecutive AIS patients hospitalized at our tertiary stroke center between January 2015 and December 2020 with available RLS status as detected on transesophageal echocardiography (TEE). Active cancers were retrospectively identified and the association with RLS was assessed with multivariable logistic regression and inverse probability of treatment weighting to minimize the ascertainment bias of having a TEE obtained.

Results: Of the 2236 AIS patients included, 103 (4.6%) had active cancer, of whom 24 (23%) were diagnosed with RLS. An RLS was present in 774 out of the 2133 AIS patients without active cancer (36%). After adjustment and weighting, the absence of RLS was associated with active cancer (adjusted odds ratio (aOR) 2.29; 95% confidence interval (CI), 1.14-4.58). When analysis was restricted to patients younger than 60 years of age or those with a high-risk RLS (Risk of Paradoxical Embolism Score ⩾ 6), there was no association between RLS and cancer (aOR, 3.07; 95% CI, 0.79-11.88 and aOR, 0.56; 95% CI, 0.10-3.10, respectively).

Conclusion: RLS was diagnosed less frequently in AIS patients with cancer than in cancer-free patients, suggesting that arterial sources may play a larger role in cancer-related strokes than paradoxical venous embolization. Future studies are needed to validate these findings and evaluate potential therapeutic implications, such as the general indication, or lack thereof, for patent foramen ovale (PFO) closure in this patient population.

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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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