Ischemic stroke classification and risk of embolism in patients with Chagas disease
Ischemic stroke classification and risk of embolism in patients with Chagas disease
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DOI：
10.1007/s00415-016-8275-0
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发表时间：
2016-12-01
影响因子：
6
通讯作者：
de Freitas, Gabriel R.
中科院分区：
文献类型：
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作者：
Abreu Montanaro, Vinicius Viana;da Silva, Creuza Maria;de Freitas, Gabriel R.
缺血性中风（IS）和恰加斯病密切相关。然而，人们很少关注这种关联及其自然历史。目前关于IS的管理和二级预防的指南主要基于不完整的信息或从其他卒中病因学知识的推断。我们进行了一项回顾性研究，比较了一群患有 IS 和恰加斯病的住院患者的中风病因。 Instituto de Pesquisa Evandro Chagas/Funda double dagger o Oswaldo Cruz (IPEC/FIOCRUZ) 栓塞评分也用于识别和评估该人群的栓塞风险。共有 86 名患者参与分析。研究人群的平均年龄为 58 岁，其中 60% 为男性。根据急性中风治疗 (TOAST) 分类中 Org 10172 的试验，45% 的中风病因不明，45% 为心源性栓塞，而停止中风研究/病因分类系统 (SSS/CCS) TOAST 表明，34% 的中风病因不明，50% 为心源性栓塞 (p < 0.01)；根据 IPEC/FIOCRUZ 评分，44% 的患者被归类为具有高栓塞风险。在不明原因的栓塞性卒中（ESUS）中，83.3%符合不明原因栓塞性卒中的标准。 SSS/CCS TOAST 病因学分类系统在识别缺血性中风和恰加斯病患者的心源性栓塞病因方面优于经典 TOAST 标准。 IPEC/FIOCRUZ 评分与确定患有心源性卒中病因的患者数量无关。应针对这一人群重新审视当前的卒中预防指南。
Ischemic stroke (IS) and Chagas disease are strongly related. Nevertheless, little attention has been paid to this association and its natural history. The current guidelines concerning the management and secondary prevention of IS are largely based on the incomplete information or extrapolation of knowledge from other stroke etiologies. We performed a retrospective study which compared stroke etiologies among a cohort of hospitalized patients with IS and Chagas disease. The Instituto de Pesquisa Evandro Chagas/Funda double dagger o Oswaldo Cruz (IPEC/FIOCRUZ) embolic score was also used to identify and evaluate the risk of embolism in this population. A total of 86 patients were included in the analysis. The mean age of the study population was 58 years, and 60 % were men. According to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) Classification, 45 % of the strokes were of undetermined etiology and 45 % of cardioembolic origin, while the Stop Stroke Study/Causative Classification System (SSS/CCS) TOAST indicated that 34 % were undetermined and 50 % cardioembolic (p < 0.01); 44 % of these patients were classified as having a high embolic risk according to the IPEC/FIOCRUZ score. Among the undetermined causes, 83.3 % fulfilled the criteria for embolic stroke of undetermined source (ESUS). The SSS/CCS TOAST etiological classification system was superior to the classical TOAST criteria in identifying a cardioembolic etiology in patients with ischemic stroke and Chagas disease. The IPEC/FIOCRUZ score did not correlate with the number of patients who were determined to have cardioembolic stroke etiologies. The current guidelines for stroke prevention should be reviewed in this population.