Internal Medicine II and Stroke Unit, San Giuseppe Hospital, Empoli, Florence, Italy.
Cardiology, San Giuseppe Hospital, Empoli, Florence, Italy.
J Thromb Thrombolysis. 2020 Jan;49(1):75-85. doi: 10.1007/s11239-019-01951-5.
Few data are available on age-related burden and characteristics of embolic stroke of undetermined source (ESUS) in the real world clinical practice. The aim of our study was to provide information about it. We retrospectively analyzed data of patients consecutively admitted to our Stroke Unit along 1 year (2017, November 1st-2018, October 31st). The etiology of ischemic stroke was defined at hospital discharge; ESUS was considered as a subset of cryptogenic stroke, and defined according to the 2014 international criteria. In the analyzed period, 306 patients, 52.3% females, mean age ± SD 77.9 ± 11.9 years, were discharged with diagnosis of ischemic stroke. Ischemic strokes of cardioembolic and lacunar origin were the most frequent subtypes: 30.1% and 29.4%, respectively. Cardioembolic strokes were particularly frequent in patients ≥ 75 years, and almost always associated with atrial fibrillation. Overall, in 80 patients (26.1%) the etiology of stroke was undetermined; in 25 (8.2%) it remained undefined because of death or severe comorbidity, making further diagnostic work-up not worthy. Cryptogenic stroke occurred in 55 patients (18%), and ESUS criteria were satisfied in 39 of them (12.7%). According to age, cryptogenic stroke was diagnosed in 21.1% (21.1% ESUS) of patients < 65 years, 24.2% (19.4% ESUS) of patients aged 65-74 years, 15.5% (9.2% ESUS) of patients ≥ 75 years. After diagnostic work-up, patent foramen ovale was most commonly associated with ESUS (17.9%), especially in patients < 65 years (62.5%); covert paroxysmal atrial fibrillation was detected in 10.5% of ESUS patients ≥ 75 years. In the real world clinical practice, the frequency of ischemic strokes of undetermined etiology, and of those satisfying ESUS criteria, is not negligible, especially in younger patients. A thorough diagnostic work-up, with an age-specific approach, is therefore necessary and of the utmost importance for the identification of stroke etiology, in order to optimize secondary stroke prevention strategies.
关于实际临床实践中不明来源栓塞性卒中（ESUS）的年龄相关负担和特征，相关数据有限。我们的研究旨在提供相关信息。我们回顾性分析了 1 年内（2017 年 11 月 1 日至 2018 年 10 月 31 日）连续收治于我们卒中病房的患者数据。患者出院时明确缺血性卒中病因；ESUS 被视为隐源性卒中的一个亚组，并根据 2014 年国际标准进行定义。在分析期间，306 名患者（52.3%为女性）出院时被诊断为缺血性卒中，平均年龄为 77.9±11.9 岁。心源性和腔隙性来源的缺血性卒中是最常见的亚型：分别为 30.1%和 29.4%。心源性卒中在≥75 岁的患者中尤为常见，且几乎总是与心房颤动相关。总的来说，80 名患者（26.1%）的卒中病因不明；由于死亡或严重合并症，25 名患者（8.2%）的病因仍未明确，因此进一步的诊断检查是不值得的。55 名患者（18%）被诊断为隐源性卒中，其中 39 名（12.7%）符合 ESUS 标准。根据年龄，<65 岁的患者中有 21.1%（21.1%为 ESUS）、65-74 岁的患者中有 24.2%（19.4%为 ESUS）、≥75 岁的患者中有 15.5%（9.2%为 ESUS）被诊断为隐源性卒中。经过诊断性检查，卵圆孔未闭是最常与 ESUS 相关的病因（17.9%），尤其是在<65 岁的患者中（62.5%）；在≥75 岁的 ESUS 患者中，检测到 10.5%的隐匿性阵发性心房颤动。在实际临床实践中，不明病因的缺血性卒中和符合 ESUS 标准的缺血性卒中的频率不可忽视，尤其是在年轻患者中。因此，需要进行全面的诊断性检查，并采用特定年龄的方法，以明确卒中病因，从而优化二级卒中预防策略。
