Salehi Omran Setareh, Chaker Salama, Lerario Mackenzie P, Merkler Alexander E, Navi Babak B, Kamel Hooman
Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, USA.
Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University Medical Center, New York, USA.
Eur Stroke J. 2020 Jun;5(2):169-173. doi: 10.1177/2396987319901201. Epub 2020 Jan 21.
About one-fourth of ischaemic strokes are classified as embolic strokes of undetermined source. Lambl's excrescences are commonly seen on cardiac valves, and data are limited on whether they may be a source of embolization. We examined the relationship between Lambl's excrescences and embolic stroke of undetermined source.
We performed a case-control study of patients in the Cornell AcutE Stroke Academic Registry. Stroke aetiologies were adjudicated using the Trial of Org 10172 in Acute Stroke Treatment and embolic stroke of undetermined source criteria. We included patients with acute ischaemic stroke between 2011 and 2016 who underwent transthoracic or transoesophageal echocardiography within six months of hospitalisation. Cases were embolic stroke of undetermined source patients and controls were patients with an identified, non-cardioembolic stroke aetiology (i.e. small- or large-vessel strokes). Multiple logistic regression was used to evaluate the association between Lambl's excrescences and embolic stroke of undetermined source after adjustment for demographics, comorbidities and mode of echocardiography.
A total of 923 patients met the criteria for this analysis, including 530 with embolic stroke of undetermined source and 393 with small- or large-vessel strokes. Lambl's excrescences were identified in 47 (8.9%) patients with embolic stroke of undetermined source and 11 (2.8%) patients with small- or large-artery strokes, but the majority (54/58) of Lambl's excrescences were visualised on transoesophageal echocardiogram and embolic stroke of undetermined source patients were more likely to undergo transoesophageal echocardiogram. After adjustment for demographics, comorbidities and mode of echocardiography, we found no association between the presence of Lambl's excrescences and embolic stroke of undetermined source (odds ratio 0.9; 95% confidence interval 0.4-2.3).
We found no association between Lambl's excrescences and embolic stroke of undetermined source. These results do not support the hypothesis that Lambl's excrescences are an occult cause of embolic stroke of undetermined source.
约四分之一的缺血性中风被归类为不明来源的栓塞性中风。兰布尔赘生物常见于心脏瓣膜，但其是否可能是栓塞的来源，相关数据有限。我们研究了兰布尔赘生物与不明来源的栓塞性中风之间的关系。
我们在康奈尔急性中风学术登记处对患者进行了一项病例对照研究。使用急性中风治疗中Org 10172试验和不明来源的栓塞性中风标准对中风病因进行判定。我们纳入了2011年至2016年间因急性缺血性中风住院且在住院六个月内接受经胸或经食管超声心动图检查的患者。病例为不明来源的栓塞性中风患者，对照为已确定非心源性栓塞性中风病因的患者（即小血管或大血管中风）。在对人口统计学、合并症和超声心动图检查方式进行调整后，使用多因素逻辑回归评估兰布尔赘生物与不明来源的栓塞性中风之间的关联。
共有923名患者符合本分析标准，其中530例为不明来源的栓塞性中风患者，393例为小血管或大血管中风患者。在不明来源的栓塞性中风患者中有47例（8.9%）发现有兰布尔赘生物，在小血管或大血管中风患者中有11例（2.8%）发现有兰布尔赘生物，但大多数（54/58）兰布尔赘生物是在经食管超声心动图上发现的，不明来源的栓塞性中风患者更有可能接受经食管超声心动图检查。在对人口统计学、合并症和超声心动图检查方式进行调整后，我们发现兰布尔赘生物的存在与不明来源的栓塞性中风之间无关联（比值比0.9；95%置信区间0.4 - 2.3）。
我们发现兰布尔赘生物与不明来源的栓塞性中风之间无关联。这些结果不支持兰布尔赘生物是不明来源的栓塞性中风隐匿病因这一假设。
