Association of Left Ventricular Hypertrophy and Atrial Fibrillation with Hemorrhagic Evolution of Small Vessel Disease
Association of Left Ventricular Hypertrophy and Atrial Fibrillation with Hemorrhagic Evolution of Small Vessel Disease
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DOI：
10.1016/j.jstrokecerebrovasdis.2021.105946
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发表时间：
2021-06-29
影响因子：
2.5
通讯作者：
Zoli，Marco
中科院分区：
文献类型：
--
作者：
Muscari，Antonio;Masetti，Giovanni;Zoli，Marco
目的脑小血管病（SVD）常合并高血压，并可向脑出血（ICH）或腔隙性缺血性卒中发展。然而，有利于ICH或腔隙性中风的演变的因素还没有得到很好的understood.Materials and MethodsThis回顾性研究包括326例连续患者（71.1±13.2岁，38%的妇女）：143深ICH和183腔隙性病变（LL）<2厘米，这是可见的在一个深的位置在脑CT扫描。在LL患者中，根据吐司分类，143例发生小动脉闭塞（SAO）卒中。前瞻性收集这些患者的临床特征和实验室及神经放射学变量，并对一个亚组进行超声心动图检查。（97%高血压），与SAO患者相比（89%高血压），左室壁厚度较大（LVWT; OR 4.15，95%CI 1.64-10.53，对于LVWT ≥ 1.4 cm的患者，其中70%为出血性），白色病变的患病率较低（OR 0.30，95%CI 0.13-0.70）、曾吸烟者（OR 0.39，95%CI 0.18-0.82）和糖尿病患者（OR 0.29，95%CI 0.10-0.84）。此外，ICH患者的房颤患病率高于LL患者（OR 3.14，95%CI 1.11-8.93），因此他们更经常抗凝治疗。结论大多数SVD患者是高血压，但那些发展为ICH的患者以心脏水平的器官损害为特征（LVWT和房颤增加），而向腔隙性卒中演变的患者的特征是吸烟者和糖尿病患者的患病率较高，以及大脑水平的器官损伤（白色物质损伤）。
ObjectivesCerebral small vessel disease (SVD) is often associated with hypertension and may evolve towards intracerebral hemorrhage (ICH) or lacunar ischemic stroke. However, the factors favoring the evolution towards ICH or lacunar stroke are not well understood.Materials and MethodsThis retrospective study included 326 consecutive patients (71.1±13.2 years, 38% women): 143 with deep ICH and 183 with lacunar lesions (LL) <2 cm, which were visible in a deep location on brain CT scan. Among LL patients, 143 had a small-artery occlusion (SAO) stroke according to the TOAST classification. Clinical characteristics plus laboratory and neuroradiological variables of these patients had been prospectively collected and a subgroup underwent echocardiography.ResultsIn multivariate analysis, ICH patients (97% hypertensive), compared to SAO patients (89% hypertensive), had greater left ventricular wall thickness (LVWT; OR 4.15, 95%CI 1.64-10.53, for those with LVWT ≥ 1.4 cm, 70% of whom were hemorrhagic) and lower prevalence of white matter lesions (OR 0.30, 95%CI 0.13-0.70), ever smokers (OR 0.39, 95%CI 0.18–0.82) and diabetics (OR 0.29, 95% CI 0.10-0.84). Moreover, ICH patients had a greater prevalence of atrial fibrillation than LL patients (OR 3.14, 95%CI 1.11-8.93), and so they were more often anticoagulated.ConclusionsMost SVD patients were hypertensive, but those evolving towards ICH were characterized by organ damage at the cardiac level (increase in LVWT and atrial fibrillation), while those evolving towards lacunar stroke were characterized by a higher prevalence of smokers and diabetics, and by organ damage at the cerebral level (white matter lesions).