使用TOAST、病因分类系统TOAST和ASCOD表型分析对恰加斯病患者中风的病因分类

Etiological Classification of Stroke in Patients with Chagas Disease Using TOAST, Causative Classification System TOAST, and ASCOD Phenotyping.

作者信息

de Paiva Bezerra Rodrigo, de Miranda Alves Maramélia Araújo, Conforto Adriana Bastos, Rodrigues Daniela Laranja Gomes, Silva Gisele Sampaio

机构信息

Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil.

出版信息

J Stroke Cerebrovasc Dis. 2017 Dec;26(12):2864-2869. doi: 10.1016/j.jstrokecerebrovasdis.2017.07.007. Epub 2017 Aug 23.

DOI:10.1016/j.jstrokecerebrovasdis.2017.07.007

PMID:28844546

Abstract

BACKGROUND

Cardioembolism is considered a major pathophysiological mechanism in patients with ischemic stroke (IS) and Chagas disease (CD). However, a previous study reported that other stroke subtypes are present in more than 40% of CD patients according to the TOAST classification. Therefore, the aim of our study was to evaluate the etiologic classification of stroke in patients with CD using the Causative Classification System (CCS), the ASCOD, and the TOAST classifications in a prospective cohort of patients.

METHODS

Patients evaluated in our outpatient clinic from 2012 to 2015 with IS and CD were included and underwent full investigation for stroke etiology. TOAST, CCS TOAST, and the ASCOD classifications were compared.

FINDINGS

We Included 32 patients (18 men; mean age 62.7 +/-10.1 years). A total of 93.8% had at least 1 vascular risk factor; the most frequent was hypertension (87.5%). According to TOAST, we defined 87.5% as having cardioembolic stroke, being 9.4% as large-artery atherosclerotic (LAA) and 3.1% as undetermined cause. Using the CCS TOAST, 62.5% were classified as cardioaortic embolism evident and 15.6% as possible, 6.3% as small artery occlusion evident and 3.1% as probable, and 12.5% as LAA evident. When ASCOD phenotyping was applied, atherosclerosis was present in 50.1% of patients (A1 = 6.3%, A3 = 43.8%), cardiac pathology in 84.4% (C1 = 62.5%, C2 = 15.6%, C3 = 6.3%), and small-vessel disease in 66% (S1 = 9.4%, S2 = 3.1%, S3 = 3.1%).

FINDINGS

In conclusion, the use of the CCS and the ASCOD phenotyping in patients with CD confirmed a high frequency of cardioembolic IS but also showed that other etiologies are prevalent, such as large-artery atherosclerosis and small-vessel occlusion.

摘要

背景

心源性栓塞被认为是缺血性卒中（IS）和恰加斯病（CD）患者的主要病理生理机制。然而，先前的一项研究报告称，根据TOAST分类，超过40%的CD患者存在其他卒中亚型。因此，我们研究的目的是在前瞻性队列患者中，使用病因分类系统（CCS）、ASCOD和TOAST分类来评估CD患者卒中的病因分类。

方法

纳入2012年至2015年在我们门诊接受评估的IS和CD患者，并对其进行卒中病因的全面调查。比较TOAST、CCS TOAST和ASCOD分类。

结果

我们纳入了32例患者（18例男性；平均年龄62.7±10.1岁）。共有93.8%的患者至少有1种血管危险因素；最常见的是高血压（87.5%）。根据TOAST分类，我们将87.5%的患者定义为心源性栓塞性卒中，9.4%为大动脉粥样硬化性（LAA），3.1%为病因不明。使用CCS TOAST分类时，62.5%被分类为明显的心主动脉栓塞，15.6%为可能的心主动脉栓塞，6.3%为明显的小动脉闭塞，3.1%为可能的小动脉闭塞，12.5%为明显的LAA。应用ASCOD表型分析时，50.1%的患者存在动脉粥样硬化（A1 = 6.3%，A3 = 43.8%），84.4%存在心脏病变（C1 = 62.5%，C2 = 15.6%，C3 = 6.3%），66%存在小血管疾病（S1 = 9.4%，S2 = 3.1%，S3 = 3.1%）。