Lattanzi Simona, Cagnetti Claudia, Pulcini Alessandra, Morelli Marco, Maffei Simone, Provinciali Leandro, Silvestrini Mauro
Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Via Conca 71, 60020 Ancona, Italy.
Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Via Conca 71, 60020 Ancona, Italy.
J Neurol Sci. 2017 Apr 15;375:175-178. doi: 10.1016/j.jns.2017.01.063. Epub 2017 Jan 24.
The Embolic Stroke of Undetermined Source (ESUS) is a recently developed clinical construct which describes stroke patients for whom the embolic source remains undetermined despite recommended investigations. The aim of the study was to characterize the ESUS population according to the abnormality in the P-wave terminal force in lead V (PTFV).
We retrospectively identified consecutive patients hospitalized for acute ischemic stroke who met the ESUS diagnostic criteria. The PTFV was obtained from the admission 12-lead ECG. Increased PTFV was defined a value >5000μV·ms. Baseline and diagnostic work-up findings were compared between the PTFV patient groups.
Among 109 patients with ESUS, 31 (28.4%) had evidence of increased PTFV. The patients with the ECG-defined left atrial abnormality had higher rates of hypertension (77.4% versus 55.1%; p=0.031), history of prior stroke or TIA (35.5% versus 16.7%; p=0.032), and moderate to severe left atrial enlargement (29.0% versus 7.7%; p=0.004) and ventricular hypertrophy (35.5% versus 16.7%; p=0.032), whereas they were less likely to have patent foramen ovale (9.7% versus 28.2%, p=0.038) and unstable sub-stenotic atherosclerosis of aortic arch and cranial arteries (12.9% versus 32.1%, p=0.041).
The abnormally increased PTFV was observed in about one third of patients with ESUS and it was inversely associated with artery-to artery and paradoxical potential sources of stroke. Left atrial cardiopathy could be involved in the ESUS pathogenesis and the ECG-defined abnormality could point towards the risk of cardiac embolism.
不明来源栓塞性卒中（ESUS）是一种最近提出的临床概念，用于描述尽管经过推荐的检查但栓塞源仍未明确的卒中患者。本研究的目的是根据V导联P波终末电势（PTFV）异常对ESUS人群进行特征描述。
我们回顾性确定了因急性缺血性卒中住院且符合ESUS诊断标准的连续患者。PTFV从入院时的12导联心电图中获取。PTFV升高定义为值>5000μV·ms。比较PTFV患者组之间的基线和诊断检查结果。
在109例ESUS患者中，31例（28.4%）有PTFV升高的证据。心电图定义的左心房异常患者的高血压发生率更高（77.4%对55.1%；p=0.031）、既往有卒中或短暂性脑缺血发作史的比例更高（35.5%对16.7%；p=0.032）、中度至重度左心房扩大的比例更高（29.0%对7.7%；p=0.004）以及心室肥厚的比例更高（35.5%对16.7%；p=0.032），而他们有卵圆孔未闭的可能性较小（9.7%对28.2%，p=0.038）以及主动脉弓和颅动脉不稳定的亚狭窄动脉粥样硬化的可能性较小（12.9%对32.1%，p=0.041）。
约三分之一的ESUS患者观察到PTFV异常升高，且其与动脉到动脉及反常性卒中潜在来源呈负相关。左心房心肌病可能参与了ESUS的发病机制，且心电图定义的异常可能提示心脏栓塞风险。
