左心室疾病作为不良结果和中风复发的危险因素,不确定来源的栓塞性中风患者中
Angelo Cascio Rizzo1, Ghil Schwarz1, Andrea Bonelli2
1Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
European stroke journal
|January 4, 2025
概括
左心室功能障碍 (LVD) 在源不明的栓塞性中风 (ESUS) 患者中很常见. 识别LVD可以改善中风风险的预测和管理,减少血管不良事件和死亡率.
科学领域:
- 心脏病学 心脏病学
- 神经学 神经学
- 血管医学 血管医学
背景情况:
- 严重的左心室 (LV) 缩功能障碍 (EF <30%) 是已知的心血管血栓风险因素.
- 较不严重的 LV 疾病 (LVD) 的作用,包括轻度至中度的功能障碍和 LV 壁运动异常 (LVWMA),在源不明的栓塞性中风 (ESUS) 中未得到充分研究.
- 在ESUS患者中,LVD可能代表潜在的心脏源.
研究的目的:
- 评估ESUS患者中LVD的患病率.
- 在ESUS中评估LVD与血管不良事件和死亡率的关联.
主要方法:
- 连续ESUS患者的回顾性,单中心研究 (2016年1月 - 2024年5月).
- LVD定义为LV射出分数 (LVEF) 30%-49%或LVWMAs,不包括最近的心肌梗塞.
- 考克斯回归分析评估了LVD与复合结果 (缺血性中风复发,急性冠状动脉事件,全因死亡率) 的关联.
主要成果:
- 在556名ESUS患者中,17.1%患有LVD (减少LVEF或LVWMAs).
- 脊髓炎患者的复合结局率 (41.0%对21.3%),中风复发率 (13.7%对5.9%),急性冠状动脉事件 (7.4%对2.4%) 和死亡率 (28.4%对15.2%) 显著提高.
- 多变量分析显示,LVD独立增加了中风复发风险 (aHR 2.13) 和复合结果 (aHR 1.92).
结论:
- 左心室功能障碍与缺血性中风复发风险增加和ESUS的不良结果显著相关.
- 在ESUS患者中识别和管理LVD对于改善长期预后至关重要.
- 对ESUS中LVD管理策略的进一步研究是有必要的.
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