Piffer Silvio, Bignamini Valeria, Rozzanigo Umberto, Poletti Piero, Merler Stefano, Gremes Elisabetta, Bonifati Domenico Marco
Department of Emergency, Section of Neurology, Santa Chiara Hospital, Trento, Italy.
Department of Emergency, Section of Neurology, Santa Chiara Hospital, Trento, Italy.
J Stroke Cerebrovasc Dis. 2018 Dec;27(12):3578-3586. doi: 10.1016/j.jstrokecerebrovasdis.2018.08.029. Epub 2018 Oct 12.
Embolic strokes of undetermined source (ESUS) represent a rather recent diagnostic entity under clinical research for relapse prevention in cryptogenic stroke patients. Despite strict diagnostic criteria, ESUS definition ignores major clinical and radiological aspects, so including heterogeneous cases and probably influencing trial results. This study researches clinically relevant phenotypes among ESUS patients.
We evaluated ESUS patients admitted at Trento Stroke Unit over a 4-year period. Vascular risk factors (RFs), neurological deficit severity, presence of potential embolic sources, and ASCOD phenotype were recorded. Ischemic lesions were categorized considering their extension in 4 groups. Subgroup comparisons by predefined differences in age, amount of RFs, history of previous stroke, deficit severity, and stroke lesion extension were done.
ESUS cases were 86. Patients younger than 50 years old (n = 17) had a lower prevalence of RFs, left atrial enlargement, left ventricle diastolic dysfunction, a higher proportion of ASCOD score A0 (P < .05). Patients without RFs (n = 18) differed from those with greater than or equal to 3 RFs (n = 23) for a younger age and a lower prevalence of potential causes of embolism (P < .05). Patients without a previous stroke (n = 70) were younger, had a lower prevalence of RFs, left ventricle diastolic dysfunction, a higher prevalence of ASCOD score A0 (P < .05). No differences were observed comparing minor and major clinical and radiological strokes.
ESUS patients can be distinguished in 2 opposite phenotypes defined by a lower and a higher load of atherosclerotic pathology. They may suggest possible underlying pathogenic mechanisms and support interpretation of ongoing trials results.
不明来源栓塞性卒中（ESUS）是临床研究中用于预防隐源性卒中患者复发的一个较新的诊断实体。尽管有严格的诊断标准，但ESUS的定义忽略了主要的临床和放射学方面，因此纳入了异质性病例，可能会影响试验结果。本研究旨在探究ESUS患者中具有临床相关性的表型。
我们评估了在特伦托卒中单元4年内收治的ESUS患者。记录血管危险因素（RFs）、神经功能缺损严重程度、潜在栓子来源的存在情况以及ASCOD表型。根据缺血性病变的范围将其分为4组。按年龄、RFs数量、既往卒中史、缺损严重程度和卒中病变范围的预定义差异进行亚组比较。
ESUS病例共86例。年龄小于50岁的患者（n = 17）RFs、左心房扩大、左心室舒张功能障碍的患病率较低，ASCOD评分A0的比例较高（P < 0.05）。无RFs的患者（n = 18）与有3个及以上RFs的患者（n = 23）相比，年龄更小，栓塞潜在病因的患病率更低（P < 0.05）。无既往卒中史的患者（n = 70）更年轻，RFs、左心室舒张功能障碍的患病率较低，ASCOD评分A0的患病率较高（P < 0.05）。在比较轻度和重度临床及放射学卒中时未观察到差异。
ESUS患者可分为由较低和较高动脉粥样硬化病理负荷定义的两种相反表型。它们可能提示潜在的致病机制，并有助于对正在进行的试验结果进行解释。
