Endovascular Stroke Therapy, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico.
Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico.
Arch Cardiol Mex. 2020;90(4):498-502. doi: 10.24875/ACM.20000202.
Left atrial disease is an independent risk factor for ischemic stroke and can be used to predict atrial fibrillation (AF). We examine whether left atrial enlargement (LAE) could predict stroke recurrence in patients with embolic stroke of undetermined source (ESUS).
Sixty-four patients with a confirmed diagnosis of ESUS were followed for a median of 22 months. Clinical data and echocardiogram findings were recorded. The echocardiogram interpretation was performed centrally and blindly. The Brown ESUS - AF score was used to categorize patients into high (human resource planning [HRP]: score > 2) and low-risk patients (non-HRP score 0-1). Stroke recurrence was the primary outcome.
The median age was 62 years (range: 22-85 years); and 33 (51.6%) were men. The median initial NIHSS score was three points (range: 0-27). Twelve (18.8%) patients were categorized as HRP. We found a significant tendency toward recurrence among HRP versus non-HRP patients. Three (25%) HRP versus 2 (3.8%) non-HRP experienced recurrence (OR: 8.3 95% CI 1.2-57; p=0.042); this association was related to severe atrial dilatation (OR: 14.5 95% CI 0.78-277, p = 0.02) and age > 75 years (OR: 12.7 95% CI 1.7-92.2, p = 0.03). We found no differences in recurrence in a univariate analysis.
Patients with severe LAE who are 75 years old or older have a significant tendency to experience stroke recurrence.
左心房疾病是缺血性卒中的独立危险因素，可用于预测心房颤动（AF）。我们研究左心房扩大（LAE）是否可预测隐源性脑栓塞（ESUS）患者的卒中复发。
64 例确诊为 ESUS 的患者接受了中位数为 22 个月的随访。记录临床数据和超声心动图检查结果。超声心动图解释由中心进行并盲法进行。采用 Brown ESUS-AF 评分将患者分为高危（HRP：评分>2）和低危（非 HRP 评分 0-1）患者。卒中复发为主要结局。
中位年龄为 62 岁（范围：22-85 岁）；33 例（51.6%）为男性。初始 NIHSS 评分为 3 分（范围：0-27）。12 例（18.8%）患者被归类为 HRP。我们发现 HRP 患者与非 HRP 患者的复发率存在显著差异。3 例（25%）HRP 患者与 2 例（3.8%）非 HRP 患者发生复发（OR：8.3，95%CI 1.2-57；p=0.042）；这种关联与严重的心房扩张（OR：14.5，95%CI 0.78-277，p=0.02）和年龄>75 岁（OR：12.7，95%CI 1.7-92.2，p=0.03）相关。我们发现单变量分析中复发无差异。
年龄>75 岁且 LAE 严重的患者卒中复发风险显著增加。
