隐源性脑卒中患者心房心脏病的多参数评估:对个性化临床管理的意义。

IF 4.5 3区 医学 Q1 CLINICAL NEUROLOGY
Iria López-Dequidt, Sonia Eiras-Penas, Adrián González-Maestro, Carlos Peña-Gil, Emilio Rodríguez-Castro, María Santamaría-Cadavid, Susana Arias-Rivas, Manuel Rodríguez-Yáñez, José María Prieto-González, José Ramón González-Juanatey, Amparo Martínez-Monzonís
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引用次数: 0

摘要

简介:隐源性卒中(CS)在病因学方面是一个异质性的群体。心房心脏病(AC)已成为这些患者卒中和心房颤动(AF)的相关潜在底物。然而,目前还没有可靠的工具可以早期准确地识别ac。材料和方法:我们进行了一项前瞻性研究,包括连续发生心房颤动(CES-AF)、非心脏栓塞性卒中(NCES)和隐源性卒中(CS)的患者。采用斑点跟踪超声心动图评估左心房应变(LAS),并采用ROC曲线分析评估CES-AF与NCES患者的血清AC指标。基于这些结果,我们建立了一个逻辑回归模型来计算CS患者AC的概率,旨在区分心栓性和非心栓性病因。比较高(>.5)和低(>.5)CS患者的临床特征。结果:共纳入136例患者:44例为CES-AF, 52例为NCES, 40例为CS。在收缩期(LASct)小于-10.2%期间,n端前脑利钠肽(NT-proBNP)水平大于或等于469 pg/mL和大于或等于-10.2%的双平面LAS的组合证明了在用于识别心脏栓塞原因的评估中表现最好的AC生物标志物组合(AUC = 0.995)。在此基础上,30%的CS患者AC预测概率为>.5。这些患者年龄较大(77.3±8岁vs 68.8±10岁,p = 0.011),卒中更严重(NIHSS评分10.1±7.5 vs 4.6±5.2,p = 0.024),随访期间房颤发生率更高(6例vs 0例,p = 0.029)。结论:NT-proBNP水平和双平面LASct的结合提供了高度敏感和特异性的AC生物标志物。这种多参数模型允许对CS患者的AC概率进行个性化估计,支持其在区分心脏栓塞与非心脏栓塞病因和指导个性化临床管理方面的潜在效用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Multiparametric assessment of atrial cardiopathy in cryptogenic stroke patients: Implications for personalized clinical management.

Introduction: Cryptogenic stroke (CS) represents a heterogeneous group in terms of etiology. Atrial cardiopathy (AC) has emerged as a relevant underlying substrate for both stroke and atrial fibrillation (AF) in these patients. However, no reliable tools are currently available for the early and accurate identification of AC.

Material and methods: We conducted a prospective study including consecutive patients with cardioembolic stroke due to AF (CES-AF), non-cardioembolic stroke (NCES) and cryptogenic stroke (CS). Left atrial strain (LAS) assessed by speckle-tracking echocardiography, and serum markers of AC were evaluated in CES-AF versus NCES patients using ROC curve analysis. Based on these results, we developed a logistic regression model to calculate the probability of AC in CS patients, aiming to discriminate between cardioembolic and non-cardioembolic etiology. Clinical characteristics were compared between CS patients with high (>0.5) and low (<0.5) predicted probability of AC.

Results: A total of 136 patients were included: 44 with CES-AF, 52 with NCES, and 40 with CS. The combination of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels ⩾ 469 pg/mL and biplanar LAS during the contraction phase (LASct) ⩾ -10.2% demonstrated the best-performing AC biomarker combination among those evaluated for identifying cardioembolic etiology (AUC = 0.995). Based on this combination, 30% of CS patients had a predicted probability > 0.5 for AC. These patients were older (77.3 ± 8 vs 68.8 ± 10 years; p = 0.011), had more severe strokes (NIHSS score 10.1 ± 7.5 vs 4.6 ± 5.2; p = 0.024) and showed a higher incidence of AF during follow-up (6 vs 0 cases; p = 0.029).

Conclusions: The combination of NT-proBNP levels and biplanar LASct provides highly sensitive and specific biomarkers of AC. This multiparametric model allows for individualized estimation of AC probability in CS patients, supporting its potential utility in discriminating cardioembolic from non-cardioembolic etiologies and guiding personalized clinical management.

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来源期刊
CiteScore
7.50
自引率
6.60%
发文量
102
期刊介绍: Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
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