Stroke Recurrence in Embolic Stroke of Undetermined Source Without Atrial Fibrillation on Invasive Cardiac Monitoring.

Autor: Tan ESJ; Department of Cardiology, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University Singapore, Singapore. Electronic address: eugene_sj_tan@nuhs.edu.sg., de Leon J; Department of Cardiology, National University Heart Centre, Singapore., Boey E; Division of Cardiology, Ng Teng Fong General Hospital, Singapore., Chin HK; Department of Neurology, National University Health System, Singapore., Ho KH; Department of Cardiology, National University Heart Centre, Singapore., Aguirre S; Department of Cardiology, National University Heart Centre, Singapore., Sim MG; Yong Loo Lin School of Medicine, National University Singapore, Singapore., Seow SC; Department of Cardiology, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University Singapore, Singapore., Sharma VK; Yong Loo Lin School of Medicine, National University Singapore, Singapore; Department of Neurology, National University Health System, Singapore., Kojodjojo P; Department of Cardiology, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University Singapore, Singapore; Division of Cardiology, Ng Teng Fong General Hospital, Singapore.
Jazyk: angličtina
Zdroj: Heart, lung & circulation [Heart Lung Circ] 2023 Aug; Vol. 32 (8), pp. 1000-1009. Date of Electronic Publication: 2023 Jun 07.
DOI: 10.1016/j.hlc.2023.05.010
Abstrakt: Background: More than half of patients with embolic stroke of undetermined source (ESUS) suffer from recurrent ischaemic stroke, despite the absence of atrial fibrillation (AF) on invasive cardiac monitoring (ICM). This study investigated the predictors and prognosis of recurrent stroke in ESUS without AF on ICM.
Method: This prospective study included patients with ESUS at two tertiary hospitals from 2015 to 2021 who underwent comprehensive neurological imaging, transthoracic echocardiography, and inpatient continuous electrographic monitoring for ≥48 hours prior to ICM for definitive exclusion of AF. Recurrent ischaemic stroke, all-cause mortality, and functional outcome by the modified Rankin scale (mRS) at 3 months were evaluated in patients without AF.
Results: Of 185 consecutive patients with ESUS, AF was not detected in 163 (88%) patients (age 62±12 years, 76% men, 25% prior stroke, median time to ICM insertion 26 [7, 123] days), and stroke recurred in 24 (15%) patients. Stroke recurrences were predominantly ESUS (88%), within the first 2 years (75%), and involved a different vascular territory from qualifying ESUS (58%). Pre-existing cancer was the only independent predictor of recurrent stroke (adjusted hazard ratio [AHR] 5.43, 95% CI 1.43-20.64), recurrent ESUS (AHR 5.67, 95% CI 1.15-21.21), and higher mRS score at 3 months (ß 1.27, 95% CI 0.23-2.42). All-cause mortality occurred in 17 (10%) patients. Adjusting for age, cancer, and mRS category (≥3 vs <3), recurrent ESUS was independently associated with more than four times greater hazard of death (AHR 4.66, 95% CI 1.76-12.34).
Conclusions: Patients with recurrent ESUS are a high-risk subgroup. Studies elucidating optimal diagnostic and treatment strategies in non-AF-related ESUS are urgently required.
(Copyright © 2023 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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