From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY (H.K.).
Biostatistics Consultant, Minot, ND (L.A.P.).
Stroke. 2020 Mar;51(3):938-943. doi: 10.1161/STROKEAHA.119.028154. Epub 2020 Jan 2.
Background and Purpose- Atrial cardiopathy and atherosclerotic plaque are two potential mechanisms underlying embolic strokes of undetermined source (ESUS). The relationship between these two mechanisms among ESUS patients remains unclear. A better understanding of their association may inform targeted secondary prevention strategies. Methods- We examined the association between atrial cardiopathy and atherosclerotic plaque in the NAVIGATE ESUS trial (New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial Versus ASA to Prevent Embolism in Embolic Stroke of Undetermined Source), which enrolled 7213 patients with recent ESUS during 2014 to 2017. For this analysis, we included patients with data on left atrial dimension, location of brain infarction, and cervical large artery plaque. The variables of primary interest were left atrial diameter and cervical plaque ipsilateral to brain infarction. Secondary markers of atrial cardiopathy were premature atrial contractions on Holter monitoring and newly diagnosed atrial fibrillation. For descriptive purposes, left atrial enlargement was defined as ≥4.7 cm. Multivariable logistic regression was used to examine the association between atrial cardiopathy markers and ipsilateral plaque after adjustment for age, sex, body mass index, hypertension, diabetes mellitus, current smoking, and hyperlipidemia. Results- Among 3983 eligible patients, 235 (5.9%) had left atrial enlargement, 939 (23.6%) had ipsilateral plaque, and 94 (2.4%) had both. Shared risk factors for left atrial enlargement and ipsilateral plaque were male sex, white race, hypertension, tobacco use, and coronary artery disease. Despite shared risk factors, increasing left atrial dimension was not associated with ipsilateral plaque after adjustment for covariates (odds ratio per cm, 1.1 [95% CI, 1.0-1.2]; =0.08). We found no consistent associations between secondary markers of atrial cardiopathy and ipsilateral plaque. Conclusions- In a large population of patients with ESUS, we did not observe a notable association between atrial cardiopathy and atherosclerotic plaque, and few patients had both conditions. These findings suggest that atrial cardiopathy and atherosclerotic plaque may be distinct, nonoverlapping risk factors for stroke among ESUS patients.
背景与目的-心房心肌病和动脉粥样硬化斑块是不明来源栓塞性卒中（ESUS）的两个潜在机制。ESUS 患者中这两种机制之间的关系尚不清楚。更好地了解它们之间的关联可能有助于制定有针对性的二级预防策略。方法-我们研究了 NAVIGATE ESUS 试验（新抗凝 Rivaroxaban 抑制因子 Xa 与阿司匹林在不明来源栓塞性卒中预防中的全球试验）中心房心肌病和动脉粥样硬化斑块之间的关系，该试验于 2014 年至 2017 年期间纳入了 7213 例近期 ESUS 患者。在这项分析中，我们纳入了有左心房大小、脑梗死部位和颈内大动脉斑块数据的患者。主要感兴趣的变量是左心房直径和脑梗死同侧的颈内动脉斑块。心房心肌病的次要标志物是动态心电图监测的房性期前收缩和新诊断的心房颤动。为了描述目的，将左心房扩大定义为≥4.7cm。多变量逻辑回归用于调整年龄、性别、体重指数、高血压、糖尿病、当前吸烟和高脂血症后，检查心房心肌病标志物与同侧斑块之间的关系。结果-在 3983 例合格患者中，235 例（5.9%）有左心房扩大，939 例（23.6%）有同侧斑块，94 例（2.4%）两者均有。左心房扩大和同侧斑块的共同危险因素是男性、白种人、高血压、吸烟和冠心病。尽管存在共同危险因素，但调整协变量后，左心房增大程度与同侧斑块无显著相关性（每厘米的优势比，1.1[95%CI，1.0-1.2]；=0.08）。我们没有发现心房心肌病的次要标志物与同侧斑块之间存在一致的关联。结论-在 ESUS 患者的大人群中，我们没有观察到心房心肌病和动脉粥样硬化斑块之间有明显的关联，而且很少有患者同时存在这两种情况。这些发现表明，心房心肌病和动脉粥样硬化斑块可能是 ESUS 患者中风的不同、非重叠的危险因素。
