缺血性卒中亚型中的临床、影像学及心房心肌病标志物——心源性栓塞来源的线索
Clinical, Imaging, and Atrial Cardiopathy Markers in Ischemic Stroke Subtypes - Clues to a Cardioembolic Source.
作者信息
Sreedharan Sapna Erat, Saikiran Kakarla, Chandralekha S C, Athira C A, Sylaja P N, Jissa V T, Namboodiri Narayanan
机构信息
Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
出版信息
Ann Indian Acad Neurol. 2025 Jul 1;28(4):568-573. doi: 10.4103/aian.aian_772_24. Epub 2025 Jan 10.
BACKGROUND AND OBJECTIVES
Cryptogenic strokes account for 20%-25% of all ischemic strokes. Although atrial cardiopathy markers are more prevalent in the cryptogenic embolic stroke of undetermined source (ESUS) subgroup than in the nonembolic stroke subgroup, the utility of individual parameters in predicting cardioembolic sources needs to be studied further. We studied the clinical, imaging, and atrial cardiopathy markers in three ischemic stroke subtypes - large artery atherosclerosis (LAA), cardioembolism (CE), and cryptogenic ESUS - and their role in predicting the source of CE.
METHODS
This was a prospective observational study of ischemic stroke patients at Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum from April 2021 to December 2022. Clinical and risk factor profiles, imaging details, atrial cardiopathy marker (N-terminal pro-brain natriuretic peptide [NT-pro-BNP]) levels, electrocardiogram (ECG) parameters (P terminal force of V1 [PTFV1], P wave duration, the PR interval), and transthoracic echo parameters (left atrial [LA] diameter and LA volume) were collected. Associations were made between clinical, imaging, and atrial cardiopathy markers and etiological subtypes.
RESULTS
We had 255 participants (LAA- 98, CE- 41, and ESUS- 139) with a mean age of 63.53 years. Among the atrial cardiopathy markers, the most prevalent was elevated NT-pro-BNP (43.95%), followed by the ECG markers P wave duration (30.92%) and PTFV1 (28.74%), and LA diameter greater than 37 mm (24.27%) and LA volume greater than 34 ml/m 2 (20.31%). Among the atrial cardiopathy markers, NT-pro-BNP and LA enlargement were strongly predictive of CE etiology, when compared to LAA. Chronic non-lacunar infarcts on imaging and elevated NT-pro-BNP showed a strong association with CE, when compared to cryptogenic strokes.
CONCLUSIONS
The atrial cardiopathy biomarker NT-pro-BNP and chronic non-lacunar infarcts can serve as useful tools for recognizing cardioembolic sources among patients with embolic strokes.
背景与目的
隐源性卒中占所有缺血性卒中的20%-25%。尽管心房病变标志物在不明来源的隐源性栓塞性卒中（ESUS）亚组中比在非栓塞性卒中亚组中更常见，但个体参数在预测心源性栓塞来源方面的效用仍需进一步研究。我们研究了三种缺血性卒中亚型——大动脉粥样硬化（LAA）、心源性栓塞（CE）和隐源性ESUS——的临床、影像学和心房病变标志物，以及它们在预测CE来源中的作用。
方法
这是一项对2021年4月至2022年12月在特里凡得琅市斯里奇特拉蒂鲁纳尔医学科学与技术研究所神经科的缺血性卒中患者进行的前瞻性观察研究。收集了临床和危险因素概况、影像学细节、心房病变标志物（N末端脑钠肽前体[NT-pro-BNP]）水平、心电图（ECG）参数（V1导联P波终末电势[PTFV1]、P波时限、PR间期）和经胸超声心动图参数（左心房[LA]直径和LA容积）。分析了临床、影像学和心房病变标志物与病因亚型之间的关联。
结果
我们纳入了255名参与者（LAA组98人、CE组41人、ESUS组139人），平均年龄为63.53岁。在心房病变标志物中，最常见的是NT-pro-BNP升高（43.95%），其次是ECG标志物P波时限（30.92%）和PTFV1（28.74%），以及LA直径大于37 mm（24.27%）和LA容积大于34 ml/m²（20.31%）。在心房病变标志物中，与LAA相比，NT-pro-BNP和LA扩大强烈预测CE病因。与隐源性卒中相比，影像学上的慢性非腔隙性梗死和NT-pro-BNP升高与CE密切相关。
结论
心房病变生物标志物NT-pro-BNP和慢性非腔隙性梗死可作为识别栓塞性卒中患者心源性栓塞来源的有用工具。
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