Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
J Neurol Sci. 2019 May 15;400:153-157. doi: 10.1016/j.jns.2019.03.031. Epub 2019 Mar 29.
Atrial fibrillation (AF) is the leading cause of cardioembolic stroke (CES), and patients with stroke and AF are frequently assumed to have CES. However, strokes presumably due to atherosclerotic pathophysiologies in large or small vessels can also occur in patients with AF. The aims of the present study were to clarify the prevalence of and factors related to a non-cardioembolic etiology in acute stroke patients with AF.
From March 2011 through May 2017, consecutive acute ischemic stroke patients with AF were retrospectively recruited. The concomitant presence of non-cardioembolic features (small vessel occlusion [SVO] or large artery atherosclerosis [LAA]) on imaging was evaluated. The frequency of and factors associated with co-existing SVO/LAA features were assessed.
A total of 560 consecutive patients with AF and acute stroke (237 women; median age 78 [IQR 71-85] years; NIHSS score 9 [3-20]) were enrolled. Of these, 42 (7.5%) had co-existing SVO/LAA features. Multivariable logistic regression analysis showed that the brain natriuretic peptide level (BNP, OR 0.78, p = .030 per 100 pg/mL increase) was independently and negatively associated with co-existing SVO/LAA features and receiver operating characteristic curve analysis revealed the practical cut-off BNP value was 130 pg/mL (sensitivity 54% and specificity 68%).
SVO/LAA features were found in 7.5% of acute stroke patients with AF. A relatively low BNP level on admission was independently associated with co-existing SVO/LAA features. Thorough examination for a more appropriate etiology may be particularly necessary in acute stroke patients with AF and a relatively low BNP level.
心房颤动（AF）是心源性脑栓塞（CES）的主要原因，患有中风和 AF 的患者通常被认为患有 CES。然而，在 AF 患者中，也可能发生归因于大或小血管动脉粥样硬化病理生理学的中风。本研究的目的是阐明伴有 AF 的急性中风患者中非心源性病因的流行情况和相关因素。
从 2011 年 3 月至 2017 年 5 月，连续回顾性招募伴有 AF 的急性缺血性中风患者。评估影像学上同时存在的非心源性特征（小血管闭塞[SVO]或大动脉粥样硬化[LAA]）。评估同时存在 SVO/LAA 特征的频率和相关因素。
共纳入 560 例伴有 AF 和急性中风的连续患者（237 例女性；中位年龄 78[IQR 71-85]岁；NIHSS 评分 9[3-20]）。其中，42 例（7.5%）存在同时存在的 SVO/LAA 特征。多变量逻辑回归分析显示，脑钠肽水平（BNP，OR 0.78，p=0.030 每增加 100pg/mL）与同时存在 SVO/LAA 特征独立且呈负相关，受试者工作特征曲线分析显示实际 BNP 截断值为 130pg/mL（敏感性 54%，特异性 68%）。
在伴有 AF 的急性中风患者中发现 SVO/LAA 特征占 7.5%。入院时相对较低的 BNP 水平与同时存在 SVO/LAA 特征独立相关。在伴有 AF 和相对较低 BNP 水平的急性中风患者中，可能特别需要进行彻底检查以确定更合适的病因。
