Steyaert Hugo, Castro Rodriguez Jose, Gazagnes Marie-Dominique, Morissens Marielle
Université Libre de Bruxelles, Brussels 1050, Belgium.
Cardiology Department, CHU Brugmann, Université Libre de Bruxelles, Brussels 1020, Belgium.
J Transl Int Med. 2022 Apr 9;10(1):48-55. doi: 10.2478/jtim-2022-0032. eCollection 2022 Mar.
Cryptogenic strokes can be defined by the criteria established for an embolic stroke of undetermined source (ESUS). Some embolic events might be caused by a left atrial septal pouch (LASP), due to the potential of thrombus formation. In this study we aimed to determine if LASP is a risk factor for ESUS when compared to a population of strokes of known origin, the LASP screening rate in our institution and if LASP dimensions influences the risk of ESUS.
We retrospectively analyzed transesophageal echocardiograms (TEEs) in a large cohort of patients that had experienced ischemic strokes. Two authors performed blinded, independent searches for LASPs by reviewing 1152 TEEs from patients that had experienced a stroke or transient ischemic attack. We excluded 26 TEEs, due to incorrect imaging. Next, we reviewed patient medical files.
Among the 1126 included patients, 148 had an ESUS (ESUS+ group) and 978 had strokes of known origin (ESUS- group). A LASP was present in 176 patients, including 32 patients (21.6% of LASPs) in the ESUS+ group and 144 patients (14.7% of LASPs) in the ESUS- group. In multivariate analysis, LASP was independently associated with ESUS ( = 0,019). 61.9% of LASPs that we found were not mentioned in reports from the original TEE operators.
This study demonstrated that LASPs were more prevalent in patients with ESUS than in patients with strokes of known origin. Our results gave rise to the question of whether anticoagulation would be appropriate for some patients with ESUS. New large-scale, prospective studies should be conducted to address this issue. Additionally, considering the low rate of LASP descriptions, we concluded that the awareness of operators should be raised to improve their success in identifying LASPs.
隐源性卒中可根据为不明来源栓塞性卒中（ESUS）制定的标准来定义。由于存在血栓形成的可能性，一些栓塞事件可能由左房隔袋（LASP）引起。在本研究中，我们旨在确定与已知病因的卒中人群相比，LASP是否为ESUS的危险因素，我们机构的LASP筛查率以及LASP尺寸是否影响ESUS风险。
我们回顾性分析了一大群缺血性卒中患者的经食管超声心动图（TEE）。两位作者通过查看1152例经历过卒中或短暂性脑缺血发作患者的TEE，对LASP进行了盲法、独立搜索。由于成像不正确，我们排除了26例TEE。接下来，我们查阅了患者的病历。
在1126例纳入患者中，148例患有ESUS（ESUS+组），978例患有已知病因的卒中（ESUS-组）。176例患者存在LASP，其中ESUS+组有32例患者（占LASP的21.6%），ESUS-组有144例患者（占LASP的14.7%）。多因素分析显示，LASP与ESUS独立相关（P = 0.019）。我们发现的LASP中有61.9%在原始TEE操作者的报告中未提及。
本研究表明，ESUS患者中LASP比已知病因的卒中患者更常见。我们的结果引发了对于某些ESUS患者抗凝是否合适的问题。应开展新的大规模前瞻性研究来解决这个问题。此外，考虑到LASP描述率较低，我们得出结论，应提高操作者的意识，以提高他们识别LASP的成功率。
