Neuroscience Institute, Hamad General Hospital, Doha, Qatar; Weill Cornell College of Medicine, Al Rayyan, Qatar.
Neuroscience Institute, Hamad General Hospital, Doha, Qatar; Weill Cornell College of Medicine, Al Rayyan, Qatar.
J Stroke Cerebrovasc Dis. 2020 Feb;29(2):104509. doi: 10.1016/j.jstrokecerebrovasdis.2019.104509. Epub 2019 Nov 20.
There is ambiguity regarding the role of left ventricle wall motion abnormalities (LVWMAs) as a potential cardioembolic source in patients, who satisfy embolic stroke of undetermined source (ESUS) criteria.
We analyzed prospectively collected data in 345 acute stroke patients, 185 (53.6%) stroke with atrial fibrillation (SwAF), and 160 (46.4%) stroke with LVWMA. LVWMA were younger (P = .003), had significantly higher frequency of stroke risk factors and lower ejection fraction (P < .001). No significant difference was found between the stroke pattern in SwAF and LVWMA except focal cortical, cortical-subcortical lesions were more frequent in LVWMA (P = .002). Mean wall motion score index (WMSI) was 1.523 (range 1.05-2.71) without any correlation between the severity of WMSI and multiple strokes (P = .976). In subgroup analyses vertical basal WMSI (P = .030) and vertical mid cavity WMSI (P = .010) was significantly related to branch arterial stroke. LVWMA 94 (65%) patients were on antiplatelet/anticoagulation compared to 47 (52.4%) with atrial fibrillation (AF), with no significant difference in stroke recurrence during 4 years follow-up (P = .15).
Patients with LVWMA who satisfy ESUS criteria, have stroke pattern on diffusion-weighted magnetic resonance imaging and risk of stroke recurrence similar to AF-related stroke despite being on appropriate antiplatelet medications. Further studies with anticoagulation therapy may be required in this group of patients to improve the high risk of recurrent stroke.
对于符合不明来源栓塞性卒中（ESUS）标准的患者，左心室壁运动异常（LVWMA）作为潜在心源性栓塞源的作用存在不确定性。
我们分析了 345 例急性卒中患者的前瞻性采集数据，其中 185 例（53.6%）为伴心房颤动（SwAF）的卒中，160 例（46.4%）为伴 LVWMA 的卒中。LVWMA 患者更年轻（P=0.003），卒中危险因素频率更高，射血分数更低（P<0.001）。SwAF 和 LVWMA 之间的卒中模式无显著差异，除皮质下病变外，皮质病灶更常见于 LVWMA（P=0.002）。壁运动评分指数（WMSI）平均值为 1.523（范围 1.05-2.71），WMSI 严重程度与多发性卒中之间无相关性（P=0.976）。亚组分析显示，基底段垂直 WMSI（P=0.030）和中段垂直 WMSI（P=0.010）与分支动脉卒中显著相关。94 例（65%）LVWMA 患者接受抗血小板/抗凝治疗，而 47 例（52.4%）伴房颤（AF）患者接受该治疗，4 年随访期间卒中复发无显著差异（P=0.15）。
符合 ESUS 标准的 LVWMA 患者尽管接受了适当的抗血小板药物治疗，但在磁共振弥散加权成像上存在卒中模式，且卒中复发风险与 AF 相关卒中相似。可能需要对该组患者进行抗凝治疗的进一步研究，以降低卒中复发的高风险。
