Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,
China National Clinical Research Center for Neurological Diseases, Beijing, China,
Cerebrovasc Dis. 2024;53(5):556-563. doi: 10.1159/000535301. Epub 2023 Nov 19.
We utilized data from the Third China National Stroke Registry to investigate the prevalence of atrial cardiopathy markers in patients with embolic stroke of undetermined source (ESUS) and to assess their association with death and stroke recurrence.
In China, patients experiencing transient ischemic attack or ischemic stroke were recruited consecutively by the Third China National Stroke Registry. We compared atrial cardiopathy markers, such as left atrial (LA) enlargement, increased P-wave terminal force in lead V1 (PTFV1), premature atrial contractions, paroxysmal supraventricular tachycardia, advanced interatrial block, prolonged PR interval, prolonged P-wave dispersion, and prolonged P-wave duration between ESUS patients and those with small vessel disease and large artery atherosclerosis strokes. The association between these markers and the recurrence of stroke as well as mortality risk in ESUS patients was evaluated using Cox regression analysis.
Of 8,528 ischemic stroke patients who underwent a standard diagnostic workup, 2,415 were identified as having ESUS. Multivariable analysis revealed a significant association between elevated PTFV1 and an increased risk of stroke recurrence (HR: 2.50; 95% CI: 1.53-4.09; p < 0.01) as well as mortality (HR: 3.76; 95% CI: 1.58-8.91; p < 0.01) at 1 year in patients with ESUS. Furthermore, we observed that moderate-severe LA enlargement slightly increased the risk of stroke recurrence in patients with ESUS (HR: 1.95; 95% CI: 0.90-4.26; p = 0.09). Both LA diameter (HR: 1.03; 95% CI: 1.00-1.06; p = 0.03) and the top quartile of the LA diameter index (HR: 1.56; 95% CI: 1.03-2.40; p = 0.04) were associated with stroke recurrence in patients with ESUS.
PTFV1 was independently associated with an elevated risk of stroke recurrence and mortality in ESUS patients. Additionally, a trend toward a correlation between LA enlargement and high stroke recurrence risk after ESUS was observed.
我们利用第三次中国国家卒中登记处的数据，调查了不明来源栓塞性卒中（ESUS）患者中心房心肌病标志物的流行情况，并评估了它们与死亡和卒中复发的关系。
在中国，通过第三次中国国家卒中登记处连续招募经历短暂性脑缺血发作或缺血性卒中的患者。我们比较了心房心肌病标志物，如左心房（LA）增大、V1 导联 P 波终末电势（PTFV1）增加、房性早搏、阵发性室上性心动过速、高级房内阻滞、PR 间期延长、P 波离散度延长和 P 波持续时间延长，在 ESUS 患者与小血管疾病和大动脉粥样硬化性卒中患者之间。使用 Cox 回归分析评估这些标志物与 ESUS 患者卒中复发和死亡风险之间的关系。
在接受标准诊断检查的 8528 例缺血性卒中患者中，有 2415 例被确定为 ESUS。多变量分析显示，ESUS 患者中 PTFV1 升高与卒中复发风险（HR：2.50；95%CI：1.53-4.09；p < 0.01）和死亡率（HR：3.76；95%CI：1.58-8.91；p < 0.01）显著相关。此外，我们观察到中重度 LA 增大略微增加了 ESUS 患者卒中复发的风险（HR：1.95；95%CI：0.90-4.26；p = 0.09）。LA 直径（HR：1.03；95%CI：1.00-1.06；p = 0.03）和 LA 直径指数的最高四分位数（HR：1.56；95%CI：1.03-2.40；p = 0.04）与 ESUS 患者的卒中复发相关。
PTFV1 与 ESUS 患者卒中复发和死亡风险增加独立相关。此外，观察到 ESUS 后 LA 增大与高卒中复发风险之间存在相关性的趋势。
