在患有心房的患者中复发性中风的临床和生物标志物决定因素:系统性审查和元分析
Yuen Cheung1, Marianne Foley1, David Bradley1
1From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (Y.C., M.F., D.B., T.C., R.C., S.C., E.D., S.G., M.O.C., M.J.O.D., P.S., D.W., P.J.K., J.J.M.); Neurovascular Unit for Applied Translational and Therapeutics Research (Y.C., M.F., S.G., P.S., P.J.K., J.J.M.), Catherine McAuley Centre; School of Medicine (Y.C., M.F., T.C., S.G., P.S., P.J.K., J.J.M.), University College Dublin; Stroke Service (Y.C., M.F., S.G., P.S., J.J.M.), Department of Geriatric Medicine, Mater Misericordiae University Hospital; School of Medicine (D.B., R.C.), Trinity College Dublin; Department of Neurology (D.B.), St James Hospital; Department of Geriatric Medicine (T.C.), St Vincent's University Hospital; Stroke Service (R.C.), Department of Geriatric Medicine, Tallaght University Hospital, Dublin; Department of Neurology (S.C.), Cork University Hospital; Clinical Neurosciences (S.C.), School of Medicine, University College Cork; Stroke Service (E.D.), Department of Geriatric Medicine, James Connolly Memorial Hospital, Dublin, Ireland; Department of Clinical Neurosciences (K.K., I.I.), University of Cambridge, Addenbrooke's Hospital, United Kingdom; Department of Neurology & Stroke Centre (M.K., A.Z.), University Hospital Basel, Switzerland; Department of Geriatric Medicine (M.O.C.), Limerick University Hospital; College of Medicine (M.J.O.D.), Nursing and Health Sciences, University of Galway and University Hospital Galway; Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences; Department of Geriatric Medicine (D.W.), and Department of Geriatric and Stroke Medicine (D.W.), Beaumont Hospital; and Stroke Service (P.J.K.), Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland.
在心房患者中,尽管服用口服抗凝剂,但心脏中风的复发风险很高. 本审查确定了临床因素和生物标志物,包括AF负担和中风尽管治疗,以改善风险预测和预防策略.
科学领域:
- 心脏病学和神经病学
- 脑卒中医学 脑卒中医学
- 生物标志物发现发现
背景情况:
- 心房 (AF) 患者每年面临复发性中风 (RS) 的严重风险 (3.2%-6.5%),即使使用口服抗凝剂 (OAC) 治疗.
- 这种高残留风险的根本原因尚不清楚,需要改进风险预测工具和用于二次预防的新疗法目标.
研究的目的:
- 系统地审查和调查临床因素,心声学,血液和神经成像生物标志物与AF相关中风患者中复发性中风 (RS) 的相关性.
主要方法:
- 在Embase和Ovid Medline进行了系统的文献搜索,直到2023年8月,包括不考虑OAC使用的研究.
- 风险比率 (RRs) 采用随机效应模型进行聚合,遵循系统审查和元分析 (PRISMA) 准则的首选报告项目.
- 包括28项研究,包括52,798名患者,有5,046个RS事件.
主要成果:
- 与RS相关的临床因素包括尽管有OAC,但中风,持续的AF,高脂血症,慢性病和恶性瘤. 美国国家卫生研究院中风量表得分和亚洲族裔与降低风险有关.
- 神经成像标志物如慢性缺口性心脏病发作,栓塞性心脏病发作和大脑微型血流与RS有关.
- 心声学标志物,如心房大小增加,心内血栓,自发左心房附属体 (LAA) 对比度和低LAA强度变化也与RS相关.
结论:
- 尽管有OAC,但AF负担和经历中风是AF相关中风后复发的临床相关因素.
- 表明心房心脏病,小血管疾病和先前心脏病发作的生物标志物与RS有关.
- 合作努力对于识别和验证AF患者RS的新型风险因素和生物标志物至关重要.
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