Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid, Spain.
Am J Physiol Heart Circ Physiol. 2024 Aug 1;327(2):H446-H453. doi: 10.1152/ajpheart.00245.2024. Epub 2024 Jun 7.
Cardioembolic stroke is one of the most devastating complications of nonischemic dilated cardiomyopathy (NIDCM). However, in clinical trials of primary prevention, the benefits of anticoagulation are hampered by the risk of bleeding. Indices of cardiac blood stasis may account for the risk of stroke and be useful to individualize primary prevention treatments. We performed a cross-sectional study in patients with NIDCM and no history of atrial fibrillation (AF) from two sources: ) a prospective enrollment of unselected patients with left ventricular (LV) ejection fraction <45% and ) a retrospective identification of patients with a history of previous cardioembolic neurological event. The primary end point integrated a history of ischemic stroke or the presence intraventricular thrombus, or a silent brain infarction (SBI) by imaging. From echocardiography, we calculated blood flow inside the LV, its residence time () maps, and its derived stasis indices. Of the 89 recruited patients, 18 showed a positive end point, 9 had a history of stroke or transient ischemic attack (TIA) and 9 were diagnosed with SBIs in the brain imaging. Averaged , [Formula: see text] performed well to identify the primary end point [AUC (95% CI) = 0.75 (0.61-0.89), = 0.001]. When accounting only for identifying a history of stroke or TIA, AUC for [Formula: see text] was 0.92 (0.85-1.00) with odds ratio = 7.2 (2.3-22.3) per cycle, < 0.001. These results suggest that in patients with NIDCM in sinus rhythm, stasis imaging derived from echocardiography may account for the burden of stroke. Patients with nonischemic dilated cardiomyopathy (NIDCM) are at higher risk of stroke than their age-matched population. However, the risk of bleeding neutralizes the benefit of preventive oral anticoagulation. In this work, we show that in patients in sinus rhythm, the burden of stroke is related to intraventricular stasis metrics derived from echocardiography. Therefore, stasis metrics may be useful to personalize primary prevention anticoagulation in these patients.
心源性脑卒是缺血性扩张型心肌病（NIDCM）最严重的并发症之一。然而，在一级预防临床试验中，抗凝的益处受到出血风险的限制。心脏血液淤滞指数可能与卒中风险相关，并有助于个体化一级预防治疗。我们在两个来源的 NIDCM 且无房颤（AF）病史的患者中进行了一项横断面研究：）前瞻性纳入左心室（LV）射血分数 <45%的未选择患者，）回顾性识别有既往心源性栓塞性神经事件史的患者。主要终点综合缺血性卒中史或存在室内心内血栓或影像学显示无症状性脑梗死（SBI）。通过超声心动图，我们计算了 LV 内血流、其驻留时间（）图及其衍生的淤滞指数。在 89 名入组患者中，18 名患者出现阳性终点，9 名患者有卒中或短暂性脑缺血发作（TIA）病史，9 名患者在脑影像学中诊断为 SBI。平均[公式：见文本]，识别主要终点[AUC（95%CI）=0.75（0.61-0.89），=0.001]效果良好。仅当考虑到识别卒中或 TIA 病史时，[公式：见文本]的 AUC 为 0.92（0.85-1.00），优势比为每周期 7.2（2.3-22.3），<0.001。这些结果表明，在窦性心律的 NIDCM 患者中，源于超声心动图的淤滞成像可能与卒中负担相关。非缺血性扩张型心肌病（NIDCM）患者的卒中风险高于同龄人群。然而，出血风险限制了预防性口服抗凝的益处。在这项工作中，我们表明，在窦性心律的患者中，卒中负担与源于超声心动图的室内心内淤滞指标相关。因此，淤滞指标可能有助于个体化这些患者的一级预防抗凝治疗。
