主动脉弓僵硬度对急性缺血性卒中患者卒中复发的影响。

Impact of aortic arch stiffness on recurrence of stroke in patients with acute ischemic stroke.

作者信息

Okuyama Hidenobu, Hirono Osamu, Tamura Harutoshi, Nishiyama Satoshi, Takeishi Yasuchika, Kayama Takamasa, Kubota Isao

机构信息

Department of Cardiology, Yamagata University School of Medicine, Yamagata, Japan.

出版信息

Circ J. 2008 Aug;72(8):1296-302. doi: 10.1253/circj.72.1296.

DOI:10.1253/circj.72.1296

PMID:18654017

Abstract

BACKGROUND

Aortic arch plaques are associated with increased risk of stroke recurrence. The atherosclerotic process also affects aortic stiffness. The purpose of the present study was to evaluate aortic arch stiffness by transesophageal echocardiography (TEE) and its effect on recurrence of stroke.

METHODS AND RESULTS

TEE was performed in 201 patients with stroke and the aortic stiffness parameter beta was measured as an expression of the elasticity of the aortic arch wall. Patients were followed during a median follow-up period of 459 days with the endpoint as stroke recurrence. There were 21 cases of stroke recurrence (10%) during the follow-up period and the stiffness parameter beta was significantly higher in those cases (16.8+/-4.6 vs 12.5+/-3.3 [no recurrence], p<0.01). Cox multivariate hazard analysis revealed that stiffness parameter beta was the only independent predictor for stroke recurrence (hazard ratio 1.683, p<0.01). Kaplan-Meier survival analysis revealed that stiffness parameter beta effectively risk stratified patients for stoke recurrence. Furthermore, in 3 groups based on the value of beta, the 3rd tertile had the highest stroke recurrent risk (relative risk 5.473, p<0.01).

CONCLUSIONS

The value of beta in the aortic arch, assessed by TEE, may be a sensitive indicator of stroke recurrence.

摘要

背景

主动脉弓斑块与中风复发风险增加相关。动脉粥样硬化过程也会影响主动脉僵硬度。本研究的目的是通过经食管超声心动图（TEE）评估主动脉弓僵硬度及其对中风复发的影响。

方法与结果

对201例中风患者进行了TEE检查，并测量了主动脉僵硬度参数β，作为主动脉弓壁弹性的指标。对患者进行了中位随访期为459天的随访，终点为中风复发。随访期间有21例中风复发（10%），这些病例的僵硬度参数β显著更高（16.8±4.6对12.5±3.3[无复发]，p<0.01）。Cox多因素风险分析显示，僵硬度参数β是中风复发的唯一独立预测因素（风险比1.683，p<0.01）。Kaplan-Meier生存分析显示，僵硬度参数β有效地对患者中风复发风险进行了分层。此外，根据β值分为3组，第三分位数组的中风复发风险最高（相对风险5.473，p<0.01）。