Division of Pediatric Neurology, Department of Pediatrics Vanderbilt University Medical Center Nashville TN.
Division of Hematology & Oncology, Department of Pediatrics Washington University School of Medicine St. Louis MO.
J Am Heart Assoc. 2024 Jun 18;13(12):e033278. doi: 10.1161/JAHA.123.033278. Epub 2024 Jun 6.
Most adults with sickle cell disease will experience a silent cerebral infarction (SCI) or overt stroke. Identifying patient subgroups with increased stroke incidence is important for future clinical trials focused on stroke prevention. Our 3-center prospective cohort study tested the primary hypothesis that adults with sickle cell disease and SCIs have a greater incidence of new stroke or SCI compared with those without SCI. A secondary aim focused on identifying additional risk factors for progressive infarcts, particularly traditional risk factors for stroke in adults.
This observational study included adults with sickle cell disease and no history of stroke. Magnetic resonance imaging scans of the brain completed at baseline and >1 year later were reviewed by 3 radiologists for baseline SCIs and new or progressive infarcts on follow-up magnetic resonance imaging. Stroke risk factors were abstracted from the medical chart. Time-to-event analysis was utilized for progressive infarcts. Median age was 24.1 years; 45.3% of 95 participants had SCIs on baseline magnetic resonance imaging. Progressive infarcts were present in 17 participants (17.9%), and the median follow-up was 2.1 years. Incidence of new infarcts was 11.95 per 100 patient-years (6.17-20.88) versus 3.74 per 100 patient-years (1.21-8.73) in those with versus without prior SCI. Multivariable Cox regression showed that baseline SCI predicts progressive infarcts (hazard ratio, 3.46 [95% CI, 1.05-11.39]; =0.041); baseline hypertension was also associated with progressive infarcts (hazard ratio, 3.23 [95% CI, 1.16-9.51]; =0.025).
Selecting individuals with SCIs and hypertension for stroke prevention trials in sickle cell disease may enrich the study population with those at highest risk for infarct recurrence.
大多数镰状细胞病患者会经历无症状性脑梗死（SCI）或显性卒中。确定卒中发生率增加的患者亚组对于未来专注于卒中预防的临床试验非常重要。我们的 3 中心前瞻性队列研究检验了主要假设，即镰状细胞病合并 SCI 的患者与无 SCI 的患者相比，新发卒中或 SCI 的发生率更高。次要目标集中于确定进展性梗死的其他危险因素，特别是成人卒中的传统危险因素。
本观察性研究纳入了无卒中史的镰状细胞病成人患者。由 3 名放射科医生对基线和 >1 年后的脑部磁共振成像（MRI）扫描进行复查，以评估基线 SCI 和随访 MRI 上新发或进展性梗死。从病历中提取卒中危险因素。采用时间事件分析评估进展性梗死。中位年龄为 24.1 岁；95 名参与者中有 45.3%在基线 MRI 上存在 SCI。17 名（17.9%）参与者存在进展性梗死，中位随访时间为 2.1 年。新发梗死的发生率为每 100 患者-年 11.95 例（6.17-20.88），而既往有 SCI 的患者为每 100 患者-年 3.74 例（1.21-8.73）。多变量 Cox 回归显示，基线 SCI 预测进展性梗死（危险比，3.46[95%CI，1.05-11.39]；=0.041）；基线高血压也与进展性梗死相关（危险比，3.23[95%CI，1.16-9.51]；=0.025）。
在镰状细胞病患者中选择合并 SCI 和高血压的个体进行卒中预防试验，可能会使研究人群中那些梗死复发风险最高的患者受益。
