Țica Otilia, Sabău Monica, Venter Alina, Beiușanu Corina, Berechet Mihail, Huniadi Anca, Șandor Mircea Ioan, Țica Ovidiu
Cardiology Clinic, Emergency County Clinical Hospital of Bihor, 410169 Oradea, Romania.
Department of Psycho-Neurosciences and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania.
Diagnostics (Basel). 2025 Sep 9;15(18):2287. doi: 10.3390/diagnostics15182287.
Dilated cardiomyopathy (DCM) is a major cause of heart failure and arrhythmic mortality; yet, its association with cerebrovascular events, particularly in the absence of atrial fibrillation (AF), remains insufficiently explored. Purpose: This study aimed to determine the prevalence, mechanisms, and anatomical distribution of stroke in patients with DCM and to assess the role of AF and structural remodeling in stroke risk. We retrospectively analyzed 471 patients who died with DCM at the Emergency County Clinical Hospital of Bihor between 1 January 2022 and 31 December 2024. Clinical records, neuroimaging, autopsy reports, and histopathological data were reviewed. Stroke subtypes were classified according to TOAST criteria (large artery atherosclerosis, cardioembolic, small vessel disease, other determined, undetermined) and hemorrhagic categories (intracerebral, subarachnoid). Demographic, echocardiographic, and comorbidity data were compared between patients with and without cerebrovascular events. Of 471 patients with DCM, 45 (9.6%) had concomitant stroke: pure ischemic in 32 (71.1%), 7 (15.6%) showed ischemic with hemorrhagic transformation, and primary hemorrhagic in 6 (13.3%). The parietal lobe was most frequently affected. AF was present in 26 patients (57.8%) and was significantly associated with ischemic stroke ( = 0.004), though embolic strokes also occurred in sinus rhythm. Patients with stroke had significantly lower left ventricular ejection fraction (28.0 ± 13.7% vs. 34.0 ± 11.2%, = 0.007) and larger atrial dimensions. Histopathological findings confirmed acute and chronic ischemic injury patterns, including "red neurons," white matter vacuolization, and gliotic scarring. Stroke is a frequent and often underdiagnosed complication in DCM, predominantly ischemic and embolic in nature. Importantly, embolic events were observed even in patients without AF, suggesting that atrial remodeling in DCM may independently predispose to cerebrovascular risk. These results underscore the need for refined preventive strategies, including careful atrial assessment and exploration of whether anticoagulation may benefit selected high-risk DCM patients without AF, a question that requires confirmation in prospective trials. Potential embolic sources in DCM include atrial cardiopathy and left ventricular thrombus in the setting of severe systolic dysfunction; therefore, careful ventricular as well as atrial assessment is warranted in high-risk DCM.
扩张型心肌病（DCM）是心力衰竭和心律失常导致死亡的主要原因；然而，其与脑血管事件的关联，尤其是在无房颤（AF）的情况下，仍未得到充分研究。目的：本研究旨在确定DCM患者中风的患病率、机制和解剖分布，并评估房颤和结构重塑在中风风险中的作用。我们回顾性分析了2022年1月1日至2024年12月31日期间在比霍尔县急诊临床医院死于DCM的471例患者。对临床记录、神经影像学、尸检报告和组织病理学数据进行了审查。中风亚型根据TOAST标准（大动脉粥样硬化、心源性栓塞、小血管疾病、其他确定型、未确定型）和出血类别（脑内、蛛网膜下腔）进行分类。比较了有和没有脑血管事件的患者的人口统计学、超声心动图和合并症数据。在471例DCM患者中，45例（9.6%）并发中风：32例（71.1%）为单纯缺血性中风，7例（15.6%）表现为缺血性中风伴出血转化，6例（13.3%）为原发性出血性中风。顶叶最常受累。26例患者（57.8%）存在房颤，且房颤与缺血性中风显著相关（P = 0.004），尽管窦性心律时也会发生栓塞性中风。中风患者的左心室射血分数显著更低（28.0±13.7% vs. 34.0±11.2%，P = 0.007），心房尺寸更大。组织病理学结果证实了急性和慢性缺血性损伤模式，包括“红色神经元”、白质空泡化和胶质瘢痕形成。中风是DCM中常见且常被漏诊的并发症，主要为缺血性和栓塞性。重要的是，即使在无房颤的患者中也观察到了栓塞事件，这表明DCM中的心房重塑可能独立增加脑血管风险。这些结果强调了需要完善预防策略，包括仔细评估心房以及探讨抗凝治疗是否可能使选定的无房颤高危DCM患者受益，这一问题需要在前瞻性试验中得到证实。DCM中的潜在栓塞来源包括心房心肌病和严重收缩功能障碍情况下的左心室血栓；因此，对高危DCM患者进行仔细的心室以及心房评估是必要的。
