Associating cryptogenic ischemic stroke in the young with cardiovascular risk factor phenotypes.
Associating cryptogenic ischemic stroke in the young with cardiovascular risk factor phenotypes.
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DOI：
10.1038/s41598-020-79499-1
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发表时间：
2021-01-11
影响因子：
4.6
通讯作者：
Esenwa C
中科院分区：
文献类型：
--
作者：
Dardick JM;Flomenbaum D;Labovitz DL;Cheng N;Liberman AL;Esenwa C
急性缺血性卒中（AIS）在年轻人中的患病率正在增加，该队列中最大的亚型是隐源性。为了遏制这一趋势，需要新的方法来定义隐源性卒中和相关的危险因素。我们的目的是深入了解隐源性卒中病例中是否存在心血管危险因素。我们对18-49岁的AIS患者进行了一项回顾性队列研究，这些患者在城市三级护理中心就诊。我们手动收集预定义的人口统计学、临床、实验室和放射学变量。通过对小血管和大血管疾病亚型（血管表型）和心源性栓塞亚型（心脏表型）患者进行多变量分析，使用这些变量确定临床风险表型。将所得表型模型应用于被认为是隐源性的病例。在449例符合标准的患者中，与心源性栓塞性AIS患者相比，小血管和大血管疾病（血管表型）患者的高血压、颅内动脉粥样硬化和糖尿病发生率较高，入院时血糖、HbA 1c、入院时血压和胆固醇较高。心源性栓塞亚组（心脏表型）的充血性心力衰竭（CHF）、风湿性心脏病、房颤、凝血障碍、左心室肥大、左心房尺寸较大、射血分数较低、B型利钠肽和肌钙蛋白水平较高。校正后的多变量分析产生了6个与血管表型独立相关的变量（年龄、男性、血红蛋白A1 c、射血分数（EF）、低密度脂蛋白（LDL）胆固醇和AIS家族史）和5个与心脏表型独立相关的变量（年龄、女性、EF降低、CHF和无颅内动脉粥样硬化）。将这些模型应用于隐源性卒中病例，51.5%符合血管表型，3.1%符合心脏表型。在我们的队列中，一半的年轻隐源性卒中患者符合小血管和大血管卒中的危险因素表型。
Acute Ischemic Stroke (AIS) in the young is increasing in prevalence and the largest subtype within this cohort is cryptogenic. To curb this trend, new ways of defining cryptogenic stroke and associated risk factors are needed. We aimed to gain insights into the presence or absence of cardiovascular risk factors in cases of cryptogenic stroke. We conducted a retrospective cohort study of patients aged 18–49 who presented to an urban tertiary care center with AIS. We manually collected predefined demographic, clinical, laboratory and radiological variables. Clinical risk phenotypes were determined using these variables through multivariate analysis of patients with the small and large vessel disease subtypes (vascular phenotype) and cardioembolic subtype (cardiac phenotype). The resultant phenotype models were applied to cases deemed cryptogenic. Within the 449 patients who met criteria, patients with small and large vessel disease (vascular phenotype) had higher rates of hypertension, intracranial atherosclerosis, and diabetes mellitus, and higher admission glucose, HbA1c, admission blood pressure, and cholesterol compared to the patients with cardioembolic AIS. The cardioembolic subgroup (cardiac phenotype) had significantly higher rates of congestive heart failure (CHF), rheumatic heart disease, atrial fibrillation, clotting disorders, left ventricular hypertrophy, larger left atrial sizes, lower ejection fractions, and higher B-type natriuretic peptide and troponin levels. Adjusted multivariate analysis produced six variables independently associated with the vascular phenotype (age, male sex, hemoglobin A1c, ejection fraction (EF), low-density lipoprotein (LDL) cholesterol, and family history of AIS) and five independently associated with the cardiac phenotype (age, female sex, decreased EF, CHF, and absence of intracranial atherosclerosis). Applying these models to cryptogenic stroke cases yielded that 51.5% fit the vascular phenotype and 3.1% fit the cardiac phenotype. In our cohort, half of young patients with cryptogenic stroke fit the risk factor phenotype of small and large vessel strokes.
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