Hosomi Naohisa, Yoshimoto Takeshi, Kanaya Yuhei, Neshige Shuichiro, Hara Naoyuki, Himeno Takahiro, Kono Ryuhei, Takeshima Shinichi, Takamatsu Kazuhiro, Ota Tomoko, Miyamoto Yoshinori, Yasuda Kotaro, Shimoe Yutaka, Ota Taisei, Kuriyama Masaru, Matsumoto Masayasu
Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan.
Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan.
J Stroke Cerebrovasc Dis. 2016 May;25(5):1165-1171. doi: 10.1016/j.jstrokecerebrovasdis.2016.02.003. Epub 2016 Feb 24.
It is important to determine the usage of anticoagulants by defining the actual risk of cardioembolic stroke in patients with old myocardial infarction. In the present study, we aimed to more precisely evaluate the risks of each segment associated with cardioembolic stroke using a 16-segment model. The usage of the plasma brain natriuretic peptide (BNP) associated with cardioembolic stroke was also evaluated in comparison with a left ventricle ejection fraction less than 40%.
There were a total of 190 ischemic stroke patients who had premorbid myocardial infarction. The study included a total of 143 ischemic stroke patients with old myocardial infarction who were available for evaluation and excluded patients with atrial fibrillation or acute myocardial infarction. Their left ventricle wall motion abnormality and the level of plasma BNP at their admission were analyzed.
Hypertension and a plasma BNP level of 206.9 pg/mL or higher, determined from the receiver operating characteristic curve, were independently associated with cardioembolic stroke (χ(2) = 35.6, R(2) = .30, P < .001). Adjusting for these factors, statistically independent high risk was observed at the basal-inferior, basal-inferolateral, mid-anterior, mid-anteroseptal, apical-anterior, and apical-septal left ventricles.
High plasma BNP levels and left ventricular wall motion abnormalities in the segments perfused with left anterior descending coronary artery or right coronary artery show a high risk for cardioembolic stroke in patients with old myocardial infarction. Considering these factors, it could be possible to more precisely define the risk of cardioembolic stroke and to perform appropriate antithrombotic treatments in old myocardial infarction patients.
通过确定陈旧性心肌梗死患者发生心源性栓塞性卒中的实际风险来决定抗凝剂的使用非常重要。在本研究中，我们旨在使用16节段模型更精确地评估与心源性栓塞性卒中相关的各节段风险。还将血浆脑钠肽（BNP）的使用情况与左心室射血分数低于40%进行比较，以评估其与心源性栓塞性卒中的关系。
共有190例患有病前心肌梗死的缺血性卒中患者。该研究共纳入了143例可进行评估的陈旧性心肌梗死缺血性卒中患者，并排除了心房颤动或急性心肌梗死患者。分析了他们入院时的左心室壁运动异常情况和血浆BNP水平。
根据受试者工作特征曲线确定，高血压和血浆BNP水平≥206.9 pg/mL与心源性栓塞性卒中独立相关（χ(2)=35.6，R(2)=0.30，P<0.001）。校正这些因素后，在左心室的基底-下壁、基底-下侧壁、中间前壁、中间前间隔、心尖前壁和心尖间隔处观察到具有统计学意义的独立高风险。
在陈旧性心肌梗死患者中，左前降支冠状动脉或右冠状动脉灌注节段的高血浆BNP水平和左心室壁运动异常显示出较高的心源性栓塞性卒中风险。考虑到这些因素，有可能更精确地界定陈旧性心肌梗死患者心源性栓塞性卒中的风险，并进行适当的抗栓治疗。
