Department of Neurology, Hannover Medical School, 30625 Hannover, Germany.
Department of Cardiology, Hannover Medical School, 30625 Hannover, Germany.
Int J Mol Sci. 2019 Feb 9;20(3):730. doi: 10.3390/ijms20030730.
A relevant part of embolic strokes of undetermined source (ESUS) is assumed to be due to non-detected atrial fibrillation (AF). In this study, we aimed to investigate if markers of endothelial dysfunction and damage may indicate AF risk in embolic stroke. Eighty-eight patients with ischemic stroke confirmed by imaging were assigned to one of three groups: ESUS, AF, or micro-/macroangiopathy. ESUS patients underwent prolonged Holter electrocardiography scheduled for three days. The National Institutes of Health Stroke Scale (NIHSS), the CHA₂DS₂VASC score, and the carotid intima⁻media thickness (CIMT) were obtained. Markers of endothelial (dys)function (L-arginine, asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA)) were measured at day seven after stroke. ESUS patients were younger and had fewer cardiovascular risk factors than patients with determined stroke etiology. Compared with AF patients, ESUS patients showed significantly lower values of SDMA ( = 0.004) and higher values of L-arginine ( = 0.031), L-arginine/ADMA ratio ( = 0.006), L-arginine/SDMA ratio ( = 0.002), and ADMA/SDMA ratio ( = 0.013). Concordant differences could be observed comparing ESUS patients with those with newly diagnosed AF ( = 0.026; = 0.03; = 0.009; = 0.004; and = 0.046, respectively). CIMT was significantly larger in AF than in ESUS patients ( < 0.001), and was identified as an AF risk factor independent from CHA₂DS₂VASC in the regression analysis ( = 0.014). These findings may support future stratification for AF risk in patients who have suffered embolic stroke.
不明来源栓塞性脑卒中（ESUS）的一个相关部分被认为是由于未检测到的心房颤动（AF）引起的。在这项研究中，我们旨在研究内皮功能和损伤的标志物是否可以提示栓塞性脑卒中的 AF 风险。通过影像学检查确诊为缺血性脑卒中的 88 名患者被分为三组之一：ESUS、AF 或微/大血管病变。ESUS 患者接受了为期三天的延长动态心电图检查。获得了美国国立卫生研究院卒中量表（NIHSS）、CHA₂DS₂VASC 评分和颈动脉内膜中层厚度（CIMT）。在脑卒中后第 7 天测量内皮（功能）障碍标志物（L-精氨酸、非对称二甲基精氨酸（ADMA）、对称二甲基精氨酸（SDMA））。与 AF 患者相比，ESUS 患者的 SDMA 值明显较低（ = 0.004），L-精氨酸值较高（ = 0.031），L-精氨酸/ADMA 比值较高（ = 0.006），L-精氨酸/SDMA 比值较高（ = 0.002），ADMA/SDMA 比值较高（ = 0.046）。与新诊断为 AF 的 ESUS 患者相比，也可以观察到一致的差异（ = 0.026； = 0.03； = 0.009； = 0.004； = 0.046）。AF 患者的 CIMT 明显大于 ESUS 患者（ < 0.001），并且在回归分析中被确定为独立于 CHA₂DS₂VASC 的 AF 风险因素（ = 0.014）。这些发现可能支持未来对栓塞性脑卒中患者的 AF 风险进行分层。
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