Yoshida Kosuke, Aburakawa Yoko, Suzuki Yasuhiro, Kuroda Kenji, Kimura Takashi
Department of Neurology, Asahikawa Medical Center, National Hospital Organization, Asahikawa, Hokkaido, Japan.
Department of Neurology, Asahikawa Medical Center, National Hospital Organization, Asahikawa, Hokkaido, Japan.
J Stroke Cerebrovasc Dis. 2018 Apr;27(4):914-918. doi: 10.1016/j.jstrokecerebrovasdis.2017.10.030. Epub 2018 Jan 3.
Patients with myotonic dystrophy type 1 have several cardiac abnormalities, especially myocardial conduction disorders. Few studies have investigated cerebral infarction. We investigated the frequency of both symptomatic and asymptomatic ischemic strokes in patients with myotonic dystrophy type 1.
Patients who were diagnosed with myotonic dystrophy type 1 using genetic testing or clinical examinations at Asahikawa Medical Center were included. We retrospectively reviewed their medical history, neuroradiological imaging, electrocardiograms, and treatment. Their CHADS2 and CHA2DS2-VASc scores were calculated.
A total of 108 patients were diagnosed with myotonic dystrophy type 1. Magnetic resonance imaging was performed in 72 and 1 patient whose results were not available was excluded. Among these, 2 patients had atrial flutter and 3 had atrial fibrillation. Regarding the CHADS2 score, 11 patients scored more than 2. Regarding the CHA2DS2-VASc score, 22 patients scored more than 2. Ischemic strokes were found in 9 patients with 1 having an atrial flutter and 4 having atrial fibrillation. All patients with stroke had CHADS2 and CHA2DS2-VASc scores higher than 2. There were significant differences between the 2 groups in atrial fibrillation (P < .001), CHADS2 score (P < .001), and CHA2DS2-VASc score (P < .001).
Ischemic stroke in patients with myotonic dystrophy type 1 is associated with atrial fibrillation. The CHADS2 score seems to be useful for the management of patients with myotonic dystrophy type 1. Repeated electrocardiograms are necessary for managing these patients.
1型强直性肌营养不良患者存在多种心脏异常，尤其是心肌传导障碍。很少有研究调查过脑梗死情况。我们调查了1型强直性肌营养不良患者有症状和无症状缺血性卒中的发生率。
纳入在旭川医疗中心通过基因检测或临床检查诊断为1型强直性肌营养不良的患者。我们回顾性分析了他们的病史、神经放射学影像、心电图及治疗情况。计算他们的CHADS2和CHA2DS2-VASc评分。
共有108例患者被诊断为1型强直性肌营养不良。72例患者进行了磁共振成像检查，排除1例结果未获取的患者。其中，2例患者有房扑，3例有房颤。关于CHADS2评分，11例患者得分超过2分。关于CHA2DS2-VASc评分，22例患者得分超过2分。9例患者发现有缺血性卒中，其中1例有房扑，4例有房颤。所有卒中患者的CHADS2和CHA2DS2-VASc评分均高于2分。两组在房颤（P < .001）、CHADS2评分（P < .001）和CHA2DS2-VASc评分（P < .001）方面存在显著差异。
1型强直性肌营养不良患者的缺血性卒中与房颤有关。CHADS2评分似乎对1型强直性肌营养不良患者的管理有用。对这些患者进行管理时需要重复进行心电图检查。
