Suzuki Masayuki, Furuya Kohei, Ozawa Misato, Miura Kumiko, Ozawa Tadashi, Matsuzono Kosuke, Mashiko Takafumi, Koide Reiji, Fujimoto Shigeru, Tanaka Ryota
Division of Neurology, Department of Medicine, Jichi Medical University.
Stroke Center, Jichi Medical University Hospital.
J Atheroscler Thromb. 2021 Jul 1;28(7):776-785. doi: 10.5551/jat.58339. Epub 2020 Sep 10.
Aortic arch atherosclerosis, particularly complex aortic arch plaques (CAPs), is an important source of cerebral emboli. CAPs and atrial fibrillation (AF) often co-exist; however, the prevalence and risk of CAPs in acute ischemic stroke patients with AF is unclear.
In patients with acute ischemic stroke with non-valvular AF admitted to Jichi Medical University Hospital during April 2016 to September 2019, we retrospectively evaluated the presence of CAPs on transesophageal echocardiography (TEE).
CAPs were observed in 41 (38.7 %) of 106 patients with non-valvular AF. Older age, diabetes mellitus, chronic kidney disease, low high-density lipoprotein cholesterol (HDL-C) levels, higher levels of glycohemoglobin A1c (HbA1c), higher CHADS and CHADS-VASc scores, and intracranial or carotid artery stenosis were more frequently observed in CAPs-positive than in CAPs-negative patients. In multivariable analyses, older age (odds ratio [OR]: 1.2 per year increase; 95% confidence interval [CI]: 1.07-1.24; P＜0.0001), diabetes mellitus (OR: 4.7; 95%CI: 1.27-17.35; P＜0.05), and low HDL-C (OR: 0.95 per 1 mg/dl increase; 95%CI: 0.92-0.99; P＜0.01) were independent risk factors for CAPs. The prevalence of CAPs was age-dependent, and there was a significantly higher risk in patients aged either 75-84 years or ＞84 years than in those aged ＜65 (OR: 7.6; 95%CI: 1.50-38.62, and OR: 32.1; 95%CI: 5.14-200.11, respectively).
Even in patients with ischemic stroke with non-valvular AF, concomitant CAPs should be considered in older individuals and those who have diabetes or low HDL-C.
主动脉弓动脉粥样硬化，尤其是复杂性主动脉弓斑块（CAPs），是脑栓塞的重要来源。CAPs与心房颤动（AF）常并存；然而，AF合并急性缺血性脑卒中患者中CAPs的患病率及风险尚不清楚。
回顾性评估2016年4月至2019年9月期间入住自治医科大学医院的非瓣膜性AF合并急性缺血性脑卒中患者经食管超声心动图（TEE）检查时CAPs的存在情况。
106例非瓣膜性AF患者中，41例（38.7%）观察到CAPs。与CAPs阴性患者相比，CAPs阳性患者年龄更大、患有糖尿病、慢性肾病、高密度脂蛋白胆固醇（HDL-C）水平低、糖化血红蛋白A1c（HbA1c）水平更高、CHADS和CHADS-VASc评分更高，以及颅内或颈动脉狭窄更为常见。在多变量分析中，年龄较大（比值比[OR]：每年增加1.2；95%置信区间[CI]：1.07 - 1.24；P＜0.0001）、糖尿病（OR：4.7；95%CI：1.27 - 17.35；P＜0.05）和低HDL-C（OR：每增加1mg/dl为0.95；95%CI：0.92 - 0.99；P＜0.01）是CAPs的独立危险因素。CAPs的患病率与年龄有关，75 - 84岁或＞84岁患者的风险显著高于＜65岁患者（OR分别为：7.6；95%CI：1.50 - 38.62，以及OR：32.1；95%CI：5.14 - 200.11）。
即使在非瓣膜性AF合并缺血性脑卒中患者中，对于年龄较大以及患有糖尿病或HDL-C低的患者，也应考虑并存CAPs的情况。
