隐蔽性脑梗死表型与首次显性缺血性脑卒中复发的关系(根据病因)。

IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY European Stroke Journal Pub Date : 2024-06-01 Epub Date: 2024-01-30 DOI:10.1177/23969873241229612
Thomas Raphael Meinel, Stefan L Leber, Michael Janisch, Jan Vynckier, Adnan Mujanovic, Anna Boronylo, Johannes Kaesmacher, David Julian Seiffge, Laurent Roten, Marcel Arnold, Christian Enzinger, Thomas Gattringer, Urs Fischer, Markus Kneihsl
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引用次数: 0

摘要

导言:隐匿性脑梗塞(CBI)是磁共振成像中经常出现的偶然发现,与无临床明显脑血管事件史的患者未来的卒中风险有关。然而,CBI 对首次发病的缺血性脑卒中患者的预后价值尚不明确,以往的研究也未报告不同病因的脑卒中亚型。我们旨在根据卒中病因检测首次发病缺血性卒中患者的 CBI 表型及其与卒中复发的关系:本研究是对伯尔尼(瑞士)和格拉茨(奥地利)综合卒中中心连续收治的两个前瞻性收集的首次缺血性卒中患者队列的汇总数据分析。入院后 72 小时内通过脑磁共振成像确定 CBI 表型。所有患者均接受了常规随访(中位数:12 个月),以确定中风是否复发:结果:在 1577 名连续缺血性中风患者(中位年龄:71 岁)中,有 691 名患者在脑部 MRI 上显示出 CBI(44%),88 名患者复发了缺血性中风(6%)。在多变量分析中,基线 CBI 与中风复发相关(HR 1.9,95% CI 1.1-3.3)。中风复发风险最高的 CBI 表型是小血管疾病(SVD)相关中风的空洞型 CBI(HR 7.1,95% CI 1.6-12.6)和心房颤动患者的皮质型 CBI(HR 3.0,95% CI 1.1-8.1):本研究报告显示,首次发生缺血性卒中的 CBI 患者卒中复发风险增加了≈2 倍。讨论与结论:本研究报告显示,患有 CBI 的首次缺血性脑卒中患者脑卒中复发风险增加≈2 倍:隐匿性脑梗塞、中风。
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Association of covert brain infarct phenotype with stroke recurrence in first-ever manifest ischemic stroke according to etiology.

Introduction: Covert brain infarcts (CBI) are frequent incidental findings on MRI and associated with future stroke risk in patients without a history of clinically evident cerebrovascular events. However, the prognostic value of CBI in first-ever ischemic stroke patients is unclear and previous studies did not report on different etiological stroke subtypes. We aimed to test CBI phenotypes and their association with stroke recurrence in first-ever ischemic stroke patients according to stroke etiology.

Patients and methods: This study is a pooled data analysis of two prospectively collected cohorts of consecutive first-ever ischemic stroke patients admitted to the comprehensive stroke centers of Bern (Switzerland) and Graz (Austria). CBI phenotypes were identified on brain MRI within 72 h after admission. All patients underwent a routine follow-up (median: 12 months) to identify stroke recurrence.

Results: Of 1577 consecutive ischemic stroke patients (median age: 71 years), 691 patients showed CBI on brain MRI (44%) and 88 patients had a recurrent ischemic stroke (6%). Baseline CBI were associated with stroke recurrence in multivariable analysis (HR 1.9, 95% CI 1.1-3.3). CBI phenotypes with the highest risk for stroke recurrence were cavitatory CBI in small vessel disease (SVD)-related stroke (HR 7.1, 95% CI 1.6-12.6) and cortical CBI in patients with atrial fibrillation (HR 3.0, 95% CI 1.1-8.1).

Discussion and conclusion: This study reports a ≈ 2-fold increased risk for stroke recurrence in first-ever ischemic stroke patients with CBI. The risk of recurrent stroke was highest in patients with cavitatory CBI in SVD-related stroke and cortical CBI in patients with atrial fibrillation.Subject terms: Covert brain infarcts, stroke.

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来源期刊
CiteScore
7.50
自引率
6.60%
发文量
102
期刊介绍: Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
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