Neuroanatomic correlates of stroke-related myocardial injury
Neuroanatomic correlates of stroke-related myocardial injury
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DOI：
10.1212/01.wnl.0000206077.13705.6d
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发表时间：
2006-05-09
期刊：
影响因子：
9.9
通讯作者：
Sorensen, AG
中科院分区：
文献类型：
--
作者：
Ay, H;Koroshetz, WJ;Sorensen, AG
背景：在没有原发心脏原因的情况下，缺血性卒中后可发生心肌损伤。卒中相关心肌损伤的神经解剖学基础尚不清楚。目的：使用一种不偏向于任何特定部位的先验假设的方法来识别与心肌损伤相关的脑梗塞区域。方法：在738例急性缺血性卒中患者中，50例在症状出现3天内无明显原因时出现血清心肌肌钙蛋白T(CTnT)升高。随机选择50例年龄和性别匹配的无cTnT升高的缺血性卒中患者作为对照。带有梗死灶轮廓的弥散加权图像被共同配准到一个模板，进行平均，然后减去，以找出两组之间不同的体素。使用非参数排列检验确定体素方向的p值，以确定与cTnT升高相关的特定梗死区。结果：研究组在卒中危险因素、冠状动脉病史、梗死体积和左右大脑中动脉受累频率方面达到了很好的平衡。与cTnT升高相关的脑区包括右后叶、上叶、内侧岛和右顶下小叶。在右侧大脑中动脉梗死患者中，88%的患者有cTnT升高，33%的患者无cTnT升高(优势比：15.00；95%可信区间：2.65~84.79)。结论：包括右脑岛在内的特定脑区的梗塞与血清心肌肌钙蛋白T水平升高有关，提示心肌损伤。
Background: Myocardial injury can occur after ischemic stroke in the absence of primary cardiac causes. The neuroanatomic basis of stroke-related myocardial injury is not well understood. Objective: To identify regions of brain infarction associated with myocardial injury using a method free of the bias of an a priori hypothesis as to any specific location. Methods: Of 738 consecutive patients with acute ischemic stroke, the authors identified 50 patients in whom serum cardiac troponin T (cTnT) elevation occurred in the absence of any apparent cause within 3 days of symptom onset. Fifty randomly selected, age- and sex-matched patients with ischemic stroke without cTnT elevation served as controls. Diffusion-weighted images with outlines of infarction were co-registered to a template, averaged, and then subtracted to find voxels that differed between the two groups. Voxel-wise p values were determined using a nonparametric permutation test to identify specific regions of infarction that were associated with cTnT elevation. Results: The study groups were well balanced with respect to stroke risk factors, history of coronary artery disease, infarction volume, and frequency of right and left middle cerebral artery territory involvement. Brain regions that were a priori associated with cTnT elevation included the right posterior, superior, and medial insula and the right inferior parietal lobule. Among patients with right middle cerebral artery infarction, the insular cluster was involved in 88% of patients with and 33% without cTnT elevation (odds ratio: 15.00; 95% CI: 2.65 to 84.79). Conclusions: Infarctions in specific brain regions including the right insula are associated with elevated serum cardiac troponin T level indicative of myocardial injury.