Priyanka Boettger, Jamschid Sedighi, Martin Juenemann, Michael Buerke, Omar Alhaj Omar
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Stroke etiology was classified according to established criteria, including ESUS definitions based on the exclusion of major cardioembolic sources, ≥50% large-artery stenosis, and small-vessel disease. All patients underwent neuroimaging, vascular diagnostics, and cardiological workup, including echocardiography and rhythm monitoring.</p><p><strong>Results: </strong>Of 714 patients, 98 (13.7%) met ESUS criteria. ESUS patients were younger (median 67 vs. 74 years), predominantly male (61.2%), and had fewer prior strokes or TIAs (11.2% vs. 27.6%, P < 0.001) than nonESUS patients. Hypertension (72.2%) and obesity (54.2%) were common. Stroke severity at discharge was lower in ESUS (National Institutes of Health Stroke (NIHSS) 1.9 ± 2.3) compared to cardioembolic (4.8 ± 3.7) and atherosclerotic strokes (3.5 ± 3.1) (P < 0.05), and no in-hospital deaths occurred in the ESUS group (P = 0.02). While overall diagnostic imaging rates were similar across groups, transesophageal echocardiography was performed more frequently in ESUS (38.8%).</p><p><strong>Conclusions: </strong>ESUS accounted for 18% of ischemic strokes and represents a distinct, clinically relevant subgroup with unique demographic and outcome profiles. 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引用次数: 0
摘要
背景和目的:引入来源不明的栓塞性卒中(ESUS),以规范可能是栓塞性的隐源性卒中的分类。然而,ESUS是一个异质性的群体,具有不同的临床和诊断特征。本研究旨在描述ESUS在前瞻性卒中队列中的特征,并将其与其他已定义的缺血性卒中亚型进行比较。方法:在这项前瞻性单中心研究中,急性缺血性卒中或短暂性脑缺血发作(TIA)患者入组时间超过6个月。卒中病因根据已建立的标准进行分类,包括基于排除主要心脏栓塞源、≥50%大动脉狭窄和小血管疾病的ESUS定义。所有患者均接受神经影像学检查、血管诊断和心脏检查,包括超声心动图和心律监测。结果:714例患者中,98例(13.7%)符合ESUS标准。与非ESUS患者相比,ESUS患者更年轻(中位年龄67岁vs. 74岁),主要为男性(61.2%),既往卒中或tia发生率更低(11.2% vs. 27.6%, P < 0.001)。高血压(72.2%)和肥胖(54.2%)较为常见。ESUS组出院时卒中严重程度(国立卫生研究院卒中(NIHSS) 1.9±2.3)低于心栓塞性卒中(4.8±3.7)和动脉粥样硬化性卒中(3.5±3.1)(P < 0.05), ESUS组未发生院内死亡(P = 0.02)。虽然各组的总体诊断率相似,但经食管超声心动图在ESUS中的应用频率更高(38.8%)。结论:ESUS占缺血性卒中的18%,代表了一个独特的、临床相关的亚组,具有独特的人口统计学和结局概况。这些发现支持ESUS分类的细化和个性化诊断和二级预防策略的需要。
Embolic Stroke of Undetermined Source (ESUS): Prevalence, Risk Factors, and Diagnostic Insights from a Prospective German Cohort.
Background and objectives: Embolic stroke of undetermined source (ESUS) was introduced to standardize the classification of cryptogenic strokes with presumed embolic origin. However, ESUS comprises a heterogeneous group with diverse clinical and diagnostic features. This study aimed to characterize ESUS within a prospective stroke cohort and compare it with other defined ischemic stroke subtypes.
Methods: In this prospective, single-center study, patients with acute ischemic stroke or transient ischemic attack (TIA) were enrolled over 6 months. Stroke etiology was classified according to established criteria, including ESUS definitions based on the exclusion of major cardioembolic sources, ≥50% large-artery stenosis, and small-vessel disease. All patients underwent neuroimaging, vascular diagnostics, and cardiological workup, including echocardiography and rhythm monitoring.
Results: Of 714 patients, 98 (13.7%) met ESUS criteria. ESUS patients were younger (median 67 vs. 74 years), predominantly male (61.2%), and had fewer prior strokes or TIAs (11.2% vs. 27.6%, P < 0.001) than nonESUS patients. Hypertension (72.2%) and obesity (54.2%) were common. Stroke severity at discharge was lower in ESUS (National Institutes of Health Stroke (NIHSS) 1.9 ± 2.3) compared to cardioembolic (4.8 ± 3.7) and atherosclerotic strokes (3.5 ± 3.1) (P < 0.05), and no in-hospital deaths occurred in the ESUS group (P = 0.02). While overall diagnostic imaging rates were similar across groups, transesophageal echocardiography was performed more frequently in ESUS (38.8%).
Conclusions: ESUS accounted for 18% of ischemic strokes and represents a distinct, clinically relevant subgroup with unique demographic and outcome profiles. These findings support the refinement of ESUS classification and the need for individualized diagnostic and secondary prevention strategies.
期刊介绍:
The journal has a clinical foundation and has been utilized most by clinical neurologists for improving the practice of neurology. While the focus is on neurology in India, the journal publishes manuscripts of high value from all parts of the world. Journal publishes reviews of various types, original articles, short communications, interesting images and case reports. The journal respects the scientific submission of its authors and believes in following an expeditious double-blind peer review process and endeavors to complete the review process within scheduled time frame. A significant effort from the author and the journal perhaps enables to strike an equilibrium to meet the professional expectations of the peers in the world of scientific publication. AIAN believes in safeguarding the privacy rights of human subjects. In order to comply with it, the journal instructs all authors when uploading the manuscript to also add the ethical clearance (human/animals)/ informed consent of subject in the manuscript. This applies to the study/case report that involves animal/human subjects/human specimens e.g. extracted tooth part/soft tissue for biopsy/in vitro analysis.