在北欧房颤和卒中研究（NOR-FIB）中，隐匿性卒中和 TIA 的潜在病因——全面临床评估的重要性。
Underlying causes of cryptogenic stroke and TIA in the nordic atrial fibrillation and stroke (NOR-FIB) study - the importance of comprehensive clinical evaluation.
机构信息
Department of Neurology, Østfold Hospital Trust, Postboks 300, Grålum, 1714, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
出版信息
BMC Neurol. 2023 Mar 21;23(1):115. doi: 10.1186/s12883-023-03155-0.
BACKGROUND
Cryptogenic stroke is a heterogeneous condition, with a wide spectrum of possible underlying causes for which the optimal secondary prevention may differ substantially. Attempting a correct etiological diagnosis to reduce the stroke recurrence should be the fundamental goal of modern stroke management.
METHODS
Prospective observational international multicenter study of cryptogenic stroke and cryptogenic transient ischemic attack (TIA) patients clinically monitored for 12 months to assign the underlying etiology. For atrial fibrillation (AF) detection continuous cardiac rhythm monitoring with insertable cardiac monitor (Reveal LINQ, Medtronic) was performed. The 12-month follow-up data for 250 of 259 initially included NOR-FIB patients were available for analysis.
RESULTS
After 12 months follow-up probable stroke causes were revealed in 43% patients, while 57% still remained cryptogenic. AF and atrial flutter was most prevalent (29%). In 14% patients other possible causes were revealed (small vessel disease, large-artery atherosclerosis, hypercoagulable states, other cardioembolism). Patients remaining cryptogenic were younger (p < 0.001), had lower CHADS-VASc score (p < 0.001) on admission, and lower NIHSS score (p = 0.031) and mRS (p = 0.016) at discharge. Smoking was more prevalent in patients that were still cryptogenic (p = 0.014), while dyslipidaemia was less prevalent (p = 0.044). Stroke recurrence rate was higher in the cryptogenic group compared to the group where the etiology was revealed, 7.7% vs. 2.8%, (p = 0.091).
CONCLUSION
Cryptogenic stroke often indicates the inability to identify the cause in the acute phase and should be considered as a working diagnosis until efforts of diagnostic work up succeed in identifying a specific underlying etiology. Timeframe of 6-12-month follow-up may be considered as optimal.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier NCT02937077, EudraCT 2018-002298-23.
背景
隐源性卒中是一种异质性疾病，其潜在病因范围广泛，最佳二级预防措施可能有很大差异。尝试做出正确的病因诊断以降低卒中复发率应是现代卒中管理的根本目标。
方法
对隐源性卒中和隐源性短暂性脑缺血发作（TIA）患者进行前瞻性观察性国际多中心研究，对这些患者进行临床监测 12 个月以确定潜在病因。为了检测心房颤动（AF），使用可植入心脏监测器（Medtronic 的 Reveal LINQ）进行连续心脏节律监测。对最初纳入的 259 例 NOR-FIB 患者中的 250 例进行了 12 个月的随访数据分析。
结果
在 12 个月的随访后，43%的患者发现了可能的卒中病因，而 57%的患者仍为隐源性病因。AF 和房扑最为常见（29%）。在 14%的患者中发现了其他可能的病因（小血管疾病、大动脉粥样硬化、高凝状态、其他心源性栓塞）。仍为隐源性病因的患者更年轻（p<0.001），入院时 CHADS-VASc 评分较低（p<0.001），NIHSS 评分（p=0.031）和 mRS 评分（p=0.016）出院时较低。仍为隐源性病因的患者吸烟更为常见（p=0.014），而血脂异常较少见（p=0.044）。与病因明确的患者相比，隐源性组的卒中复发率更高，分别为 7.7%和 2.8%（p=0.091）。
结论
隐源性卒中常常表明在急性期无法确定病因，应将其视为一种待诊诊断，直到诊断性检查成功确定特定的潜在病因。6-12 个月的随访时间可能被认为是最佳的。
试验注册
ClinicalTrials.gov 标识符 NCT02937077，EudraCT 2018-002298-23。
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