白质病变是伴有高风险卵圆孔未闭的隐源性脑卒中复发的预后标志。

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2024-10-30 DOI:10.1016/j.jstrokecerebrovasdis.2024.108048

Shunichi Niiyama MD , Yuji Ueno MD, PhD , Naohide Kurita MD, PhD , Sho Nakajima MD, PhD , Chikage Kijima MD, PhD , Kenichiro Hira MD, PhD , Nobukazu Miyamoto MD, PhD , Masao Watanabe MD, PhD , Kazuo Yamashiro MD, PhD , Takao Urabe MD, PhD , Nobutaka Hattori MD, PhD

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引用次数: 0

摘要

目的：高风险的卵圆孔未闭（PFO）可能是隐源性卒中的病因，而房间隔动脉瘤（ASA）会增加卵圆孔未闭（PFO）隐源性卒中患者卒中复发的风险。与 PFO 特征相关的脑卒中复发因素尚未得到全面评估：本研究采用了接受经食道超声心动图检查的缺血性卒中患者的多中心观察登记数据。患者被分为三组：高危 PFO、PFO 伴有大分流（≥20 个微泡）或 ASA；右至左分流（RLS）、RLS 包括 PFO：共分析了 586 名患者（185 名女性；65.5±13.2 岁）。在中位随访 4.2 年（四分位间范围 1.0-6.1）的隐源性中风（329 例）患者中，55 例患者中风复发。阴性 RLS、RLS 和高危 PFO 组分别有 179、90 和 60 名患者，其中中风复发率分别为每人每年 5.3%、2.5% 和 4.6%。在高危 PFO 患者中，美国国立卫生研究院卒中量表评分（危险比 [HR] 1.257 [1.034-1.530]）和脑室周围高密度（HR 3.369 [1.103-10.294]）是多变量 Cox 危险分析中卒中复发的预测因素，但在 RLS 组和阴性 RLS 组中没有任何因素与卒中复发有关：结论：研究表明，室周高密度可预测高危 PFO 患者的卒中复发。

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White matter lesions as a prognostic marker of recurrence in cryptogenic stroke with high-risk patent foramen ovale

Purpose

A high-risk patent foramen ovale (PFO) could be the cause of cryptogenic stroke, and an atrial septal aneurysm (ASA) increases the risk of stroke recurrence in cryptogenic stroke patients with a patent foramen ovale (PFO). Factors related to stroke recurrence according to PFO characteristics have not been fully evaluated.

Methods

Data from a multicenter, observational registry of ischemic stroke patients undergoing transesophageal echocardiography were used for this study. Patients were classified into three groups: high-risk PFO, PFO with large shunt (≥20 microbubbles) or ASA; right-to-left shunt (RLS), RLS including PFO with <20 microbubbles or without ASA, or pulmonary arteriovenous fistula; and negative RLS. Cox proportional hazards regression analysis was used to explore the factors related to stroke recurrence in these three groups.

Results

In total, 586 patients (185 females; 65.5±13.2 years) were analyzed. In cryptogenic stroke (329 patients) with median follow-up of 4.2 (interquartile range, 1.0–6.1) years, 55 patients had stroke recurrence. The negative RLS, RLS, and high-risk PFO groups included 179, 90, and 60 patients, in which stroke recurrence occurred in 5.3%, 2.5%, and 4.6% per person-year, respectively. In patients with high-risk PFO, the National Institutes of Health stroke scale score (hazard ratio [HR] 1.257 [1.034-1.530]) and periventricular hyperintensity (HR 3.369 [1.103-10.294]) were predictors of stroke recurrence on multivariable Cox hazards analysis, but no factors were related to stroke recurrence in the RLS and negative RLS groups.

Conclusion

Periventricular hyperintensity was shown to predict recurrent stroke in patients with a high-risk PFO.

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.