Lee Hsun-Hua, Huang Li-Kai, Chang Hwai-Jan, Wu Dean, Chi Nai-Fang, Chan Lung, Hu Chaur-Jong, Chen Chih-Chung
Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
Dizziness and Balance Disorder Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
Front Neurol. 2019 Jan 18;9:1198. doi: 10.3389/fneur.2018.01198. eCollection 2018.
Association between net vertebral artery flow volume (NVAFV) and stroke types remains unclear. We hypothesize NVAFV is low in patients with posterior circulation infarction (PCI) and an ideal cut-off value for discriminating PCI from anterior circulation infarction (ACI) and controls may be present. As study candidates, we retrospectively enrolled hospitalized patients with first-time non-AF stroke within 2-years period. Consecutive non-AF, non-stroke subjects were enrolled as the control group. We compared NVAFV values among the PCI, ACI, and control groups. Overall, 866 candidates-213, 418, and 235 candidates in the PCI, ACI, and control groups, respectively-were enrolled. NVAFV (mean ± SD) values were 134.8 ± 52.7, 152.3 ± 59.2, and 172.0 ± 54.7 mL/min in the PCI, ACI, and control groups, respectively. Statistics revealed significant difference ( < 0.001) among three groups. To use NVAFV as a diagnostic parameter, the AUC of any two groups should be between 0.58 and 0.69. Most (93.6%) of the controls had NVAFV above 100 mL/min. The odds ratio of any non-AF stroke is 3.48 if the NVAFV is below 100 mL/min. NVAFV is lowest in non-AF PCI group. Low NVAFV is associated with both non-AF ACI and PCI. No ideal cut-off value is available to discriminate PCI from other two conditions. We agree that an NVAFV of 100 mL/min is the lower limit of a normal value. Any value below 100 mL/min indicates high stroke risk and implies diffuse cerebral atherosclerosis and impaired cerebral perfusion.
椎动脉净血流量(NVAFV)与卒中类型之间的关联尚不清楚。我们推测后循环梗死(PCI)患者的NVAFV较低,可能存在一个区分PCI与前循环梗死(ACI)及对照的理想临界值。作为研究对象,我们回顾性纳入了2年内首次发生非房颤卒中的住院患者。连续纳入非房颤、非卒中受试者作为对照组。我们比较了PCI组、ACI组和对照组的NVAFV值。总体而言,共纳入866名受试者,其中PCI组213名、ACI组418名、对照组235名。PCI组、ACI组和对照组的NVAFV(均值±标准差)值分别为134.8±52.7、152.3±59.2和172.0±54.7 mL/分钟。统计学分析显示三组间存在显著差异(<0.001)。若将NVAFV用作诊断参数,任意两组之间的曲线下面积(AUC)应在0.58至0.69之间。大多数(93.6%)对照组受试者的NVAFV高于100 mL/分钟。若NVAFV低于100 mL/分钟,任何非房颤卒中的比值比为3.48。非房颤PCI组的NVAFV最低。低NVAFV与非房颤ACI和PCI均相关。尚无理想的临界值可用于区分PCI与其他两种情况。我们认为100 mL/分钟是NVAFV的正常值下限。任何低于100 mL/分钟的值都表明卒中风险高,提示弥漫性脑动脉粥样硬化和脑灌注受损。