Aortic atheromas and acute ischemic stroke: A transesophageal echocardiographic study in an ethnically mixed population
Aortic atheromas and acute ischemic stroke: A transesophageal echocardiographic study in an ethnically mixed population
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DOI：
10.1212/wnl.46.6.1560
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发表时间：
1996-06-01
期刊：
影响因子：
9.9
通讯作者：
Homma, S
中科院分区：
文献类型：
--
作者：
DiTullio, MR;Sacco, RL;Homma, S
目的：近端主动脉粥样硬化被认为是老年人缺血性卒中的潜在决定因素，尤其是在不明原因（隐源性）卒中的病例中。我们的目的是通过比较急性缺血性卒中患者和无卒中对照受试者中近端主动脉粥样硬化的发生率，评估其作为卒中独立危险因素的潜在作用。动脉粥样硬化的频率也比较了不同种族，患者和方法：病例对照研究进行了106例急性缺血性脑卒中患者和114例无脑卒中对照组。通过双平面经食管超声心动图评估主动脉近端部分是否存在动脉粥样硬化。动脉粥样硬化根据其厚度（0.2至0.4 cm，小;大于或等于0.5 cm，大）和复杂性（即，溃疡或活动性。主动脉粥样硬化和缺血性卒中之间的关系进行了测试，控制患者的人口统计学变量和卒中危险因素。在中风患者中，进行亚组分析以检测软动脉粥样硬化和中风诊断亚型（确定原因与隐源性）之间的相关性，并通过多普勒检查检测颈动脉狭窄的存在和程度。结果如下：卒中患者大动脉粥样硬化的发生率高于对照组（26% vs 13%;粗比值比[OR] 2.4，95% CI 1.2 - 4.7）;溃疡或移动的动脉粥样硬化在卒中患者中也更常见（12% vs 5%; OR 2.5，95% CI 1.0 - 6.8）。差异完全归因于年龄≥ 60岁的患者亚组，其中溃疡或移动的动脉粥样硬化的频率在隐源性卒中患者中特别高（22% vs 8%（i）对照受试者; OR 3.4，95%; CI 1.1 - 11.2）。多变量分析显示，在整个研究组中，大动脉粥样硬化的存在与卒中独立相关，校正OR 2.6。95% CI 1.1 - 5.9）和老年亚组（OR 2.4，95% CI 1.1 - 5.7）。颈动脉狭窄≥ 60%随着主动脉粥样硬化的大小和复杂性的增加而更常见，但对大动脉粥样硬化的预测价值较低（16%）;此外，36%的轻度或无颈动脉狭窄的患者有大或复杂的主动脉粥样硬化。不同种族的动脉粥样硬化发生率无显著差异。结论：在60岁或以上的患者中，近端主动脉粥样硬化大于或等于0.5 cm是缺血性卒中的危险因素。溃疡性或移动的动脉粥样硬化可能在解释老年人某些隐源性卒中中起一定作用。不同种族的主动脉粥样硬化患者的卒中风险可能相似。没有颈动脉狭窄并不能排除主动脉粥样硬化是缺血性卒中的潜在原因。
Purpose: Proximal aortic atheromas have been suggested as a potential ischemic stroke determinant in tile elderly, especially in cases of unexplained (cryptogenic) stroke. Our aim was to assess the potential role of proximal aortic atheromas as an independent risk factor for stroke by comparing their frequency in patients with acute ischemic stroke and in stroke-free control subjects. The frequency of atheromas was also compared among different ethnic groups, Patients and Methods: A case-control study was conducted in 106 patients with acute ischemic stroke and 114 stroke-free control subjects. The presence of atheromas of the proximal portion of the aorta was assessed by biplane transesophageal echocardiography. Atheromas were categorized on the basis of their thickness (0.2 to 0.4 cm, small; greater than or equal to 0.5 cm, large) and complexity (i.e., ulceration or mobility,. The association between aortic atheromas and ischemic stroke was tested, controlling for patients' demographic variables and stroke risk factors. In stroke patients, subgroup analyses were performed to test the associations between softie atheromas and stroke diagnostic subtypes (determined cause versus cryptogenic) and presence and degree of carotid stenoses by duplex Doppler examination. Results: The frequency of large aortic atheromas was greater in stroke patients than in controls (26% versus 13%; crude odds ratio [OR] 2.4, 95% CI 1.2 to 4.7); ulcerated or mobile atheromas also tended to be more frequent in stroke patients (12% versus 5%; OR 2.5, 95% CI 1.0 to 6.8). Differences were entirely attributable to the subgroup of patients aged 60 years or older, in whom the frequency of ulcerated or mobile atheromas was particularly high among cryptogenic stroke patients (22% versus 8% (i)n control subjects; OR 3.4, 95%; CI 1.1 to 11.2). Multivariate analysis showed the presence of large atheromas to be independently associated with stroke in the entire study group adjusted OR 2.6. 95% CI 1.1 to 5.9) and in the older subgroup (OR 2.4, 95% CI 1.1 to 5.7). Carotid stenosis greater than or equal to 60% was more frequent with increasing size and complexity of aortic atheromas but had low predictive value (16%) for presence of large atheromas; moreover, 36% of patients with mild or no carotid stenosis had large or complex aortic atheromas. No significant differences were found in the frequency of atheromas by ethnic up. Conclusions: Proximal aortic atheromas greater than or equal to 0.5 cm in size are a risk factor for ischemic stroke in patients aged 60 years or older. Ulcerated or mobile atheromas may play a role in explaining some cryptogenic strokes in the elderly. The risk for stroke of patients with aortic atheromas may be similar across different ethnic groups. The absence of carotid stenosis does not exclude aortic atheromas as a potential cause for ischemic stroke.