Department of Neurology (G.M.G., S.B., N.L.Z., M.M.G., R.S., H.W., K.W.), Hannover Medical School, Germany.
Department of Cardiology and Angiology (J.-T.S., S.B., U.B.), Hannover Medical School, Germany.
Stroke. 2020 Dec;51(12):3737-3741. doi: 10.1161/STROKEAHA.120.030537. Epub 2020 Oct 12.
Approximately one-sixth of all ischemic strokes are attributable to embolic stroke of undetermined source (ESUS). Recent analyses suggest that atrial cardiopathy and nonstenotic carotid plaque (nsCP) may represent 2 distinct underlying causes in patients with ESUS, although both diseases share common risk factors and are pathophysiologically intertwined. In this study, we, therefore, aimed to search for associations between nsCP and markers of atrial remodeling and function in patients with embolic stroke.
Sixty-eight patients with ESUS or atrial fibrillation (AF)-related stroke proven by imaging who underwent comprehensive echocardiographic studies, including measurements of left atrial function and remodeling, were considered. Patients with ESUS underwent a follow-up of at least 1 year after index stroke. For 20 patients with ESUS, NT-proBNP (N-terminal pro-B-type natriuretic peptide) values were available. Presence of nsCP was evaluated considering Duplex sonography and computed tomography angiography and was further categorized in possibly or probably symptomatic nsCP.
ESUS patients with nsCP tended to have higher values of septal and lateral total atrial conduction times (=0.071 and =0.072, respectively), left atrial volume index (=0.077), and revealed significantly higher strain rates during early diastole (=0.013) as well as higher NT-proBNP values (=0.010) than ESUS patients without nsCP. Moreover, septal total atrial conduction time was significantly longer in ESUS patients with possibly symptomatic nsCP compared with those without (=0.015). Comparison of ESUS with AF patients revealed significantly higher proportions of nsCP (=0.010), possibly symptomatic nsCP (=0.037), and probably symptomatic nsCP (=0.036) in patients with atrial fibrillation-related stroke. In the regression analysis adjusted for vascular risk factors probably symptomatic nsCP remained significantly associated with AF (=0.048, odds ratio: 4.46 [95% CI, 1.02-19.56]).
Presence of nsCP is associated with AF and markers of left atrial disease in patients with embolic stroke. Therefore, a thorough evaluation regarding atrial cardiopathy and AF in patients with ESUS should not be restricted if nsCP are found, even if high-risk plaque characteristics are evident.
约六分之一的缺血性中风可归因于来源不明的栓塞性中风（ESUS）。最近的分析表明，心房心脏病和非狭窄性颈动脉斑块（nsCP）可能代表 ESUS 患者的 2 种不同潜在病因，尽管这两种疾病有共同的危险因素，并在病理生理学上相互交织。在这项研究中，我们旨在寻找 ESUS 患者的 nsCP 与心房重构和功能标志物之间的相关性。
共纳入 68 例经影像学证实为 ESUS 或与心房颤动（AF）相关的中风患者，这些患者接受了全面的超声心动图检查，包括左心房功能和重构的测量。ESUS 患者在指数中风后至少进行了 1 年的随访。对于 20 例 ESUS 患者，可获得 NT-proBNP（N 末端脑钠肽前体）值。通过双功能超声和计算机断层血管造影术评估 nsCP 的存在，并进一步分类为可能或可能有症状的 nsCP。
ESUS 伴有 nsCP 的患者的间隔和侧壁总心房传导时间（分别为 0.071 和 0.072）、左心房容积指数（=0.077）较高，舒张早期应变率（=0.013）较高，NT-proBNP 值（=0.010）较高，而 ESUS 不伴有 nsCP 的患者则较低。此外，ESUS 伴有可能有症状的 nsCP 的患者的间隔总心房传导时间明显长于无 nsCP 的患者（=0.015）。与 AF 患者的 ESUS 比较显示，AF 相关中风患者中 nsCP（=0.010）、可能有症状的 nsCP（=0.037）和可能有症状的 nsCP（=0.036）的比例明显更高。在调整血管危险因素的回归分析中，可能有症状的 nsCP 与 AF 仍显著相关（=0.048，比值比：4.46[95%可信区间，1.02-19.56]）。
在栓塞性中风患者中，nsCP 的存在与 AF 和左心房疾病的标志物有关。因此，如果发现 nsCP，即使有高危斑块特征，也不应仅限于对 ESUS 患者进行心房心脏病和 AF 的全面评估。
