Department of Medicine Tokyo Women's Medical University Adachi Medical Center Tokyo Japan.
Department of Neurology Tokyo Women's Medical University Tokyo Japan.
J Am Heart Assoc. 2024 Aug 6;13(15):e033634. doi: 10.1161/JAHA.123.033634. Epub 2024 Jul 31.
This study aimed to clarify the characteristics and survival prediction value of transcranial Doppler microembolic signals (MES) in patients with acute cerebral infarction and active cancer.
Between 2017 and 2022, 1089 cases of acute cerebral infarction were recorded within 7 days of disease onset. Among them, transcranial Doppler was successful in 33 patients who had active cancer, and these data were analyzed in this study. The primary outcomes were stroke recurrence and mortality at 3 months. The study population had the following characteristics [median (interquartile range)]: age, 70 years (63-78); body mass index, 21.6 (20-24), National Institutes of Health Stroke Scale 3 (1-6), and modified Rankin Scale score at discharge 1 (1-4). The most common cancer types were lung (24%), pancreatic (24%), and intestinal (18%). MES was present in 16 of 33 patients (48.5%). The presence and number of MES were significantly associated with the levels of D-dimer ( <0.001) and C-reactive protein (=0.012). Moreover, the presence of MES was associated with multiple ischemic lesions and the 3-territory sign on magnetic resonance imaging. Of the 33 patients, 9 died at 3 months, and 1 had stroke recurrence. On Cox multivariate analysis, using the MES-negative group as a reference, the presence of MES was significantly associated with all-cause death (adjusted hazard ratio, 12.19 [95% CI, 1.45-216.85]; =0.020).
In patients with acute ischemic stroke and active cancer, the presence of MES was associated with D-dimer and C-reactive protein levels and multiple and 3-territory ischemic lesions, and was predictive of short-term survival.
本研究旨在阐明伴有活动期癌症的急性脑梗死患者经颅多普勒微栓子信号（MES）的特征和生存预测价值。
2017 年至 2022 年间，记录了 1089 例发病后 7 天内的急性脑梗死病例。其中，33 例伴有活动期癌症的患者经颅多普勒检查成功，对这些数据进行了分析。主要结局为 3 个月时的卒中复发和死亡率。研究人群具有以下特征[中位数（四分位距）]：年龄 70 岁（63-78 岁）；体重指数 21.6（20-24），国立卫生研究院卒中量表 3 分（1-6 分），出院时改良 Rankin 量表评分 1 分（1-4 分）。最常见的癌症类型为肺癌（24%）、胰腺癌（24%）和肠癌（18%）。33 例患者中 16 例存在 MES（48.5%）。MES 的存在和数量与 D-二聚体（ <0.001）和 C 反应蛋白（=0.012）水平显著相关。此外，MES 的存在与磁共振成像上的多发性缺血性病灶和 3 个区域征相关。33 例患者中，9 例在 3 个月时死亡，1 例发生卒中复发。在 Cox 多变量分析中，以 MES 阴性组为参照，MES 的存在与全因死亡显著相关（调整后的危险比 12.19[95%可信区间，1.45-216.85]；=0.020）。
在伴有急性缺血性卒中且有活动期癌症的患者中，MES 的存在与 D-二聚体和 C 反应蛋白水平以及多发性和 3 个区域的缺血性病灶相关，并可预测短期生存。
