Tao Lin, Dai Ying-Jie, Shang Zi-Yang, Li Xiao-Qiu, Wang Xin-Hong, Ntaios George, Chen Hui-Sheng
Department of Neurology, General Hospital of Northern Theatre command, Shenyang, Liaoning, China.
Department of Internal Medicine, University of Thessaly, Volos, Greece.
J Neurol Neurosurg Psychiatry. 2022 Apr;93(4):351-359. doi: 10.1136/jnnp-2021-327517. Epub 2021 Dec 6.
To assess (1) the association between atrial cardiopathy (AC) and non-stenotic intracranial complicated atherosclerotic plaque (NICAP) in patients with embolic stroke of undetermined source (ESUS) or small-vessel disease (SVD), and (2) the performance of previously proposed biomarkers to identify AC as the underlying aetiology in ESUS.
Based on our high-resolution MRI (HR-MRI) cohort, 403 subjects (243 ESUS and 160 SVD) were enrolled in the final analysis. All patients underwent intracranial HR-MRI to assess the presence of ipsilateral NICAP. Biomarkers of AC (ie, P-wave terminal force in lead V1 (PTFV1) on ECG, N-terminal probrain natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T and left atrial diameter) were collected within 24 hours after admission.
Among patients without ipsilateral NICAP, we found an association between the presence of AC (adjusted OR (aOR): 4.76, 95% CI 2.48 to 9.14), increased PTFV1 (aOR: 5.70, 95% CI: 2.43 to 13.39) and NT-proBNP (aOR: 1.65, 95% CI: 1.16 to 2.35) with ESUS. This association was not evident among patients with ipsilateral NICAP. The discrimination between ESUS versus SVD by AC/AC-related biomarkers was significantly improved after excluding ipsilateral NICAP. Similarly, the discrimination between ESUS and SVD by ipsilateral NICAP was notably augmented after excluding AC, PTFV1 and NT-proBNP.
AC is more prevalent in patients who had ESUS without ipsilateral NICAP compared with patients with, implying that AC and ipsilateral NICAP are two distinct, competing aetiologies of ESUS. Among the AC biomarkers studied in this analysis, PTFV1 seems to be the most informative.
评估（1）不明来源栓塞性卒中（ESUS）或小血管病（SVD）患者中心房心肌病（AC）与非狭窄性颅内复杂性动脉粥样硬化斑块（NICAP）之间的关联，以及（2）先前提出的生物标志物在识别ESUS潜在病因AC方面的性能。
基于我们的高分辨率MRI（HR-MRI）队列，403名受试者（243例ESUS和160例SVD）纳入最终分析。所有患者均接受颅内HR-MRI检查以评估同侧NICAP的存在情况。入院后24小时内收集AC的生物标志物（即心电图V1导联P波终末电势（PTFV1）、N末端脑钠肽前体（NT-proBNP）、高敏心肌肌钙蛋白T和左心房直径）。
在无同侧NICAP的患者中，我们发现AC的存在（校正比值比（aOR）：4.76，95%可信区间2.48至9.14）、PTFV1升高（aOR：5.70，95%可信区间：2.43至13.39）和NT-proBNP（aOR：1.65，95%可信区间：1.16至2.35）与ESUS相关。在有同侧NICAP的患者中，这种关联不明显。排除同侧NICAP后，AC/AC相关生物标志物对ESUS与SVD的鉴别能力显著提高。同样，排除AC、PTFV1和NT-proBNP后，同侧NICAP对ESUS和SVD的鉴别能力也显著增强。
与有同侧NICAP的患者相比，无同侧NICAP的ESUS患者中AC更为普遍，这意味着AC和同侧NICAP是ESUS两种不同的、相互竞争的病因。在本分析中研究的AC生物标志物中，PTFV1似乎信息量最大。
