Sadiq Eitzaz, Woodiwiss Angela, Norton Gavin, Modi Girish
Division of Neurology, Department of Neurosciences, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, South Africa.
Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, South Africa.
BMJ Neurol Open. 2024 Aug 1;6(2):e000592. doi: 10.1136/bmjno-2023-000592. eCollection 2024.
Cardioembolic stroke (CES) appears to be a rare cause of stroke (4%-9%) in people living with HIV (PLWH) in sub-Saharan Africa (SSA). However, due to limited access to diagnostic resources, this may be an underestimate. It is also unclear which cardiac pathologies are the major contributors to CES in this region. We sought to determine the prevalence and aetiology of CES in PLWH and to determine whether there are any differences compared with HIV negative stroke patients.
This cross-sectional study recruited PLWH with new-onset stroke at a quaternary-level hospital in Johannesburg, South Africa, from 2014 to 2017, and compared them to age-matched and sex-matched HIV negative stroke patients. Comprehensive investigations were performed to determine the underlying stroke aetiology, including electrocardiography, echocardiography, CT angiography and cerebrospinal fluid examination.
85 PLWH with ischaemic stroke were recruited and compared with 109 HIV negative controls. CES was identified in 17/85 (20.0%) of PLWH. These patients had more severe strokes than PLWH with non-CES (National Institutes of Health Stroke Scale score 14.9±6.7 vs 11.7±5.4, p=0.04). Cardiomyopathy was the predominant cardiac pathology in PLWH (76.4% vs 45.5% in HIV negative, p=0.04) while valvulopathy was more common in HIV negative patients (42.4% vs 11.8% in PLWH, p=0.03). Arrhythmia (n=1) and ischaemic heart disease (n=1) were uncommon in PLWH.
CES is underdiagnosed in SSA and is more severe than non-CES. The identification of cardiomyopathy as the predominant underlying cardiac pathology may assist to target resources towards its detection using accessible cost-effective biomarkers.
在撒哈拉以南非洲地区（SSA）的人类免疫缺陷病毒感染者（PLWH）中，心源性栓塞性卒中（CES）似乎是卒中的罕见病因（4%-9%）。然而，由于获取诊断资源有限，这一比例可能被低估。目前尚不清楚该地区导致CES的主要心脏病理情况。我们旨在确定PLWH中CES的患病率和病因，并确定与HIV阴性卒中患者相比是否存在差异。
这项横断面研究于2014年至2017年在南非约翰内斯堡的一家四级医院招募了新发卒中的PLWH，并将他们与年龄和性别匹配的HIV阴性卒中患者进行比较。进行了全面检查以确定潜在的卒中病因，包括心电图、超声心动图、CT血管造影和脑脊液检查。
招募了85例缺血性卒中的PLWH，并与109例HIV阴性对照进行比较。在17/85（20.0%）的PLWH中确诊为CES。这些患者的卒中比非CES的PLWH更严重（美国国立卫生研究院卒中量表评分14.9±6.7 vs 11.7±5.4，p=0.04）。心肌病是PLWH中主要的心脏病理情况（76.4% vs HIV阴性患者中的45.5%，p=0.04），而瓣膜病在HIV阴性患者中更常见（42.4% vs PLWH中的11.8%，p=0.03）。心律失常（n=1）和缺血性心脏病（n=1）在PLWH中不常见。
在SSA地区，CES诊断不足且比非CES更严重。将心肌病确定为主要的潜在心脏病理情况，可能有助于利用可获取的经济有效的生物标志物，针对性地投入资源进行检测。
