Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan.
J Neurol Sci. 2012 Oct 15;321(1-2):54-7. doi: 10.1016/j.jns.2012.07.049. Epub 2012 Aug 19.
The symptoms of about 30% of acute ischemic stroke patients progress, but the mechanism and predictors of the deterioration are not well known. The augmentation index (AIx), estimated with the arterial pulse waveform, is known to be pathophysiologically relevant to the pathogenesis of cardiovascular diseases. The aim of the present study was to investigate the prognostic value of the AIx for early symptom progression (ESP) in patients with acute ischemic stroke.
Acute ischemic stroke patients admitted to our stroke center within 24h from onset were prospectively enrolled. The AIx was measured within 48 h from admission. ESP was defined as ≥ 2 increase in the NIHSS score during 7 days from admission. All patients were divided into 2 groups according to the ESP (the ESP group and the non-ESP group).
A total of 147 patients (79 males, median age 74 [IQR 64-82]years, and NIHSS score 3 [1-7]) were enrolled. ESP was observed in 23 (16%) patients. There were no differences in clinical characteristics including the AIx between the two groups. However, when only cases with lacunar and atherothrombotic strokes were evaluated, the AIx was higher in the ESP group (37.0 [32.0-38.0]%) than in the non-ESP group (29.5 [21.8-33.3]%, p=0.003). With the optimal cut-off value of >36%, the AIx was independently associated with ESP (OR 37.3, 95% CI 1.71-811, p=0.021).
The AIx level was independently related to ESP in patients with acute lacunar and atherothrombotic strokes. The AIx may have a potential to predict ESP in these patients.
约 30%的急性缺血性脑卒中患者的症状会进展，但病情恶化的机制和预测因素尚不清楚。动脉脉搏波形态估计的增强指数（AIx）已知与心血管疾病的发病机制有病理生理学相关性。本研究旨在探讨 AIx 对急性缺血性脑卒中患者早期症状进展（ESP）的预后价值。
前瞻性纳入发病 24 小时内入我院卒中中心的急性缺血性脑卒中患者。入院后 48 小时内测量 AIx。ESP 定义为入院后 7 天内 NIHSS 评分增加≥2 分。所有患者根据 ESP（ESP 组和非 ESP 组）分为两组。
共纳入 147 例患者（79 例男性，中位年龄 74 [IQR 64-82]岁，NIHSS 评分 3 [1-7]）。23 例（16%）患者出现 ESP。两组间临床特征，包括 AIx 均无差异。然而，当仅评估腔隙性和动脉粥样硬化血栓性卒中病例时，ESP 组 AIx 高于非 ESP 组（37.0 [32.0-38.0]% vs. 29.5 [21.8-33.3]%，p=0.003）。当 AIx＞36%为最佳截断值时，AIx 与 ESP 独立相关（OR 37.3，95%CI 1.71-811，p=0.021）。
AIx 水平与急性腔隙性和动脉粥样硬化血栓性卒中患者的 ESP 独立相关。AIx 可能有潜力预测这些患者的 ESP。
