Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea.
J Clin Neurosci. 2019 Nov;69:214-219. doi: 10.1016/j.jocn.2019.07.050. Epub 2019 Jul 18.
Even after extensive standard evaluation, the probable cause of stroke in some patients remains unclear; this condition is defined as cryptogenic stroke (CS). The prognosis of patients with CS is largely undetermined. We investigated whether higher brachial-ankle pulse wave velocities (baPWVs) can predict poor functional outcomes at 3 months after stroke onset in these patients. We investigated patients with CS with first-ever acute cerebral infarction who underwent baPWV measurements. The stroke subtypes were classified using the Trial of ORG 10172 in Acute Stroke Treatment classification. Poor functional outcomes were defined as modified Rankin Scale scores of >2 at 3 months after stroke onset. In total, 595 patients with CS were included; among them, 360 were men (60.5%). Their mean age was 65.0 ± 12.4 years. One-hundred-eleven patients (18.7%) had poor functional outcomes. In the multivariable logistic regression analysis, the cutoff baPWV value based on the receiver-operating characteristic curve was >1968 cm/s, which was determined as a strong independent predictor (OR 3.159, 95% CI 1.487-6.715, p = 0.003). The OR of the cutoff value was higher in the patients with CS with initial National Institutes of Health Stroke Scale (NIHSS) scores of ≥5 (OR 4.252, 95% CI 1.596-11.324, p = 0.004); that in the patients with initial NIHSS scores of <5 was not significant (OR 1.671, 95% CI 0.620-4.505, p = 0.310). baPWV measurement during the acute stroke phase might be useful in identifying patients with CS at high risks of having a poor neurological prognosis.
即使经过广泛的标准评估，一些患者中风的可能原因仍不清楚；这种情况被定义为隐源性中风 (CS)。CS 患者的预后在很大程度上尚不确定。我们研究了在这些患者中风发作后 3 个月时，较高的肱踝脉搏波速度 (baPWV) 是否可以预测较差的功能结局。我们研究了首次发生急性脑梗死的 CS 患者，这些患者接受了 baPWV 测量。中风亚型使用 ORG 10172 在急性中风治疗分类中的分类进行分类。较差的功能结局定义为中风发作后 3 个月时改良 Rankin 量表评分 >2。共纳入 595 例 CS 患者；其中 360 例为男性 (60.5%)。他们的平均年龄为 65.0±12.4 岁。111 例 (18.7%) 有较差的功能结局。在多变量逻辑回归分析中，基于受试者工作特征曲线的截断 baPWV 值为 >1968 cm/s，这被确定为一个强有力的独立预测因素 (OR 3.159, 95% CI 1.487-6.715, p=0.003)。在 NIHSS 评分初始≥5 的 CS 患者中，截断值的 OR 更高 (OR 4.252, 95% CI 1.596-11.324, p=0.004)；而 NIHSS 评分初始<5 的患者的 OR 则不显著 (OR 1.671, 95% CI 0.620-4.505, p=0.310)。在急性中风阶段进行 baPWV 测量可能有助于识别具有不良神经预后风险的 CS 患者。
