Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan.
J Am Heart Assoc. 2017 Sep 11;6(9):e005955. doi: 10.1161/JAHA.117.005955.
The prevalence of cerebral microbleeds (CMBs) in gradient echo T2*-weighted brain MRI has a positive correlation with hemorrhagic stroke incidence. However, the prevalence of CMBs in patients with left ventricular assist devices (LVADs) has not been evaluated. We evaluated the prevalence of CMBs and the relationship with hemorrhagic stroke incidence in patients with LVADs.
We analyzed results from brain MRI in prospective examinations of 35 consecutive patients who had undergone LVAD explantation for heart transplantation or recovery since 2011. The number and distribution of CMBs were counted, then the relationship between baseline characteristics and adverse events during LVAD support were analyzed. The mean age was 37.7±12.4 years and the mean LVAD duration was 2.43±1.08 years. Thirty-four (97%) patients had at least one CMB. Nine (26%) developed hemorrhagic stroke during LVAD support, and patients with hemorrhagic stroke had a significantly greater number of CMBs compared with patients without hemorrhagic stroke (5 [interquartile range (IQR), 4-7] versus 9 [IQR, 5-23]; odds ratio 1.14 [95% Confidence Interval (CI), 1.02-1.32], =0.05). There was no significant relationship between age, LVAD support duration, or systolic blood pressure during LVAD. However, patients who had at least one episode of bacteremia (9 [IQR, 4-16] versus 5 [IQR, 3-7], =0.06) and pump pocket infection (14 [IQR, 4-27] versus 5 [IQR, 3-7], =0.08) showed a trend toward a greater number of CMBs than patients without bacteremia.
Thirty-four (97%) patients with continuous-flow LVAD had at least one CMB, and the number of CMBs were more prevalent in patients with hemorrhagic stroke and in patients with LVAD-related infection.
梯度回波 T2*-加权脑 MRI 中脑微出血（CMB）的患病率与出血性卒中的发生率呈正相关。然而，左心室辅助装置（LVAD）患者的 CMB 患病率尚未得到评估。我们评估了 LVAD 患者的 CMB 患病率以及与出血性卒中发生率的关系。
我们分析了 2011 年以来因心脏移植或恢复而接受 LVAD 取出术的 35 例连续患者前瞻性检查的脑 MRI 结果。计数 CMB 的数量和分布，然后分析基线特征与 LVAD 支持期间不良事件之间的关系。患者的平均年龄为 37.7±12.4 岁，LVAD 持续时间的平均为 2.43±1.08 年。34 例（97%）患者至少有一个 CMB。9 例（26%）在 LVAD 支持期间发生出血性卒中，与未发生出血性卒中的患者相比，发生出血性卒中的患者 CMB 数量明显更多（5 [四分位距（IQR），4-7] 与 9 [IQR，5-23]；比值比 1.14 [95%置信区间（CI），1.02-1.32]，=0.05）。年龄、LVAD 支持时间或 LVAD 期间的收缩压与 CMB 数量之间无显著关系。然而，至少发生一次菌血症（9 [IQR，4-16] 与 5 [IQR，3-7]，=0.06）和泵套感染（14 [IQR，4-27] 与 5 [IQR，3-7]，=0.08）的患者比没有菌血症的患者 CMB 数量更多。
34 例（97%）连续血流 LVAD 患者至少有一个 CMB，出血性卒中患者和 LVAD 相关感染患者的 CMB 数量更为常见。
