年龄改变不明来源栓塞性脑卒中患者左心房增大和非狭窄性颈动脉斑块的发生率。
Age Alters Prevalence of Left Atrial Enlargement and Nonstenotic Carotid Plaque in Embolic Stroke of Undetermined Source.
机构信息
Cooper Medical School of Rowan University, Camden, NJ (S.O, L.T., N.V., S.K., J.H., P.P.).
Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia (B.L.C., S.R.-E.).
出版信息
Stroke. 2022 Jul;53(7):2260-2267. doi: 10.1161/STROKEAHA.121.037522. Epub 2022 Mar 31.
BACKGROUND
Nonstenotic carotid plaque and undetected atrial fibrillation are potential mechanisms of embolic stroke of undetermined source (ESUS), but it is unclear which is more likely to be the contributing stroke mechanism. We explored the relationship between left atrial enlargement (LAE) and nonstenotic carotid plaque across age ranges in an ESUS population.
METHODS
A retrospective multicenter cohort of consecutive patients with unilateral, anterior circulation ESUS was queried (2015 to 2021). LAE and plaque thickness were determined by transthoracic echocardiography and computed tomography angiography, respectively. Descriptive statistics were used to compare plaque features in relation to age and left atrial dimensions.
RESULTS
Among the 4155 patients screened, 273 (7%) met the inclusion criteria. The median age was 65 years (interquartile range [IQR] 54-74), 133 (48.7%) were female, and the median left atrial diameter was 3.5 cm (IQR 3.1-4.1). Patients with any LAE more frequently had hypertension (85.9% versus 67.2%, <0.01), diabetes (41.0% versus 25.6%, =0.01), dyslipidemia (56.4% versus 40.0%, =0.01), and coronary artery disease (22.8% versus 11.3%, =0.02). Carotid plaque thickness was greater ipsilateral versus contralateral to the stroke hemisphere in the overall cohort (median 1.9 mm [IQR 0-3] versus 1.5 mm [IQR 0-2.6], <0.01); however, this was largely driven by the subgroup of patients without any LAE (median 1.8 mm [IQR 0-2.9] versus 1.5 mm [IQR 0-2.5], <0.01). Compared with patients ≥70 years, younger patients had more carotid plaque ipsilateral versus contralateral (mean difference 0.42 mm±1.24 versus 0.08 mm±1.54, =0.047) and less moderate-to-severe LAE (6.3% versus 15.3%, =0.02).
CONCLUSIONS
Younger patients with ESUS had greater prevalence of ipsilateral nonstenotic plaque, while the elderly had more LAE. The differential effect of age on the probability of specific mechanisms underlying ESUS should be considered in future studies.
背景
非狭窄性颈动脉斑块和未检测到的心房颤动是非狭窄性颈动脉斑块引起的不明来源栓塞性卒中（ESUS）的潜在机制，但尚不清楚哪种机制更可能是导致卒中的机制。我们探讨了 ESUS 人群中左心房扩大（LAE）与非狭窄性颈动脉斑块在不同年龄段之间的关系。
方法
回顾性分析了 2015 年至 2021 年间连续单侧前循环 ESUS 患者的多中心队列。通过经胸超声心动图和计算机断层血管造影术分别确定 LAE 和斑块厚度。使用描述性统计比较了与年龄和左心房大小相关的斑块特征。
结果
在筛选的 4155 例患者中，273 例（7%）符合纳入标准。中位年龄为 65 岁（四分位距 [IQR] 54-74），133 例（48.7%）为女性，中位左心房直径为 3.5cm（IQR 3.1-4.1）。有任何 LAE 的患者更常患有高血压（85.9%比 67.2%，<0.01）、糖尿病（41.0%比 25.6%，=0.01）、血脂异常（56.4%比 40.0%，=0.01）和冠心病（22.8%比 11.3%，=0.02）。与对侧相比，卒中半球同侧的颈动脉斑块厚度更大（总体队列中中位数 1.9mm [IQR 0-3]比 1.5mm [IQR 0-2.6]，<0.01）；然而，这主要是由无任何 LAE 的患者亚组驱动的（中位数 1.8mm [IQR 0-2.9]比 1.5mm [IQR 0-2.5]，<0.01）。与≥70 岁的患者相比，年轻患者同侧颈动脉斑块更多（平均差异 0.42mm±1.24 比 0.08mm±1.54，=0.047），中度至重度 LAE 较少（6.3%比 15.3%，=0.02）。
结论
ESUS 年轻患者同侧非狭窄性斑块更为常见，而老年患者 LAE 更多。在未来的研究中，应考虑年龄对 ESUS 潜在机制的具体概率的差异影响。
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