Atrial Cardiopathy and Cryptogenic Stroke: A Cross-sectional Pilot Study.
Atrial Cardiopathy and Cryptogenic Stroke: A Cross-sectional Pilot Study.
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DOI：
10.1016/j.jstrokecerebrovasdis.2015.09.001
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发表时间：
2016-01
期刊：
影响因子：
--
通讯作者：
Elkind MS
中科院分区：
文献类型：
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作者：
Yaghi S;Boehme AK;Hazan R;Hod EA;Canaan A;Andrews HF;Kamel H;Marshall RS;Elkind MS
越来越多的证据表明，左房功能不全或心脏病与独立于房颤的缺血性卒中风险相关。我们的目的是确定心房性心脏病生物标志物在不明原因卒中患者中的患病率。我们纳入了2008年12月1日至2012年4月30日期间在纽约哥伦比亚大学急性卒中转化性研究合作专门项目登记的连续的缺血性卒中患者。回顾了医疗记录，并确定了被诊断为隐源性中风的患者。房性心脏病的诊断标准为：血清N末端脑利钠肽原250pg/m L，心电图P波终末速度V1(PTFV1)和Gt；5000μV*ms，或超声心动图左房重度增大。我们比较了房性心脏病患者和非房性心脏病患者的临床、超声心动图和放射学特征。在40例不明原因卒中患者中，63%的患者至少有一个房性心脏病的生物标志物；49%的患者NT-proBNP升高，20%的患者心电图有PTFV1升高的证据，5%的患者有严重的LAE。患有房性心脏病的患者年龄更大(76岁比62岁；p=0.012)；有高血压(96%比33%，p=0.001)、高脂血症(60%比27%，p=0.033)或冠心病(28%比0%，p=0.033)，并且不太可能有卵圆孔未闭(4%比40%，p=0.007)。在隐源性卒中患者中，房性心脏病的生物标志物有很高的患病率。需要临床试验来确定这些患者是否可能受益于抗凝以预防中风。
There is increasing evidence that left atrial dysfunction or cardiopathy is associated with ischemic stroke risk independently of atrial fibrillation. We aimed to determine the prevalence of atrial cardiopathy biomarkers in patients with cryptogenic stroke. We included consecutive patients with ischemic stroke enrolled in the New York Columbia Collaborative Specialized Program of Translational Research in Acute Stroke registry between December 1st, 2008 and April 30th, 2012. Medical records were reviewed and patients with a diagnosis of cryptogenic stroke were identified. Atrial cardiopathy was defined as at least one of the following: serum N- terminal pro brain natriuretic peptide (NT pro-BNP)>250 pg/mL, P-wave terminal force velocity in lead V1 on electrocardiogram (PTFV1) >5000 μV*ms, or severe left atrial enlargement (LAE) on echocardiogram. We compared clinical, echocardiographic, and radiological characteristics between patients with and without atrial cardiopathy. Among 40 patients with cryptogenic stroke, 63% had at least one of the biomarkers of atrial cardiopathy; 49% had elevated NT-proBNP, 20% had evidence of increased PTFV1 on ECG, and 5% had severe LAE. Patients with atrial cardiopathy were more likely to be older (76 vs. 62 years; p=0.012); have hypertension (96% vs. 33%, p<0.001), hyperlipidemia (60% vs. 27%, p=0.05), or coronary heart disease (28% vs. 0%, p=0.033), and less likely to have a patent foramen ovale(4% vs. 40%, p=0.007). There is a high prevalence of biomarkers indicative of atrial cardiopathy in patients with cryptogenic stroke. Clinical trials are needed to determine whether these patients may benefit from anticoagulation to prevent stroke.