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    Home > Active Ingredient News > Study of Nervous System > JNNP: Atrial heart disease and non-stenotic complex intracranial atherosclerotic plaque in patients with embolic stroke of unknown origin

    JNNP: Atrial heart disease and non-stenotic complex intracranial atherosclerotic plaque in patients with embolic stroke of unknown origin

    • Last Update: 2021-12-26
    • Source: Internet
    • Author: User
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    The term embolic stroke of undetermined origin (ESUS) is used to describe non-lacunar infarcts that occur without significant proximal arterial stenosis, major cardiogenic embolism, or other specific causes
    .
    Occult atrial fibrillation was originally thought to be the main mechanism of ESUS

    .
    Current evidence suggests that atrial heart disease (AC) is independent of atrial fibrillation and is an important potential source of embolism in ESUS

    .
    AC-related ECG (such as P-wave terminal force in lead V1 (PTFV1), supraventricular premature beats), biochemical (such as C-reactive protein, N-terminal precursor natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T ( Hs-cTnT) and structural abnormalities (such as left atrial diameter (LAD)) are independently associated with cryptogenic stroke/ESUS

    .
    Aortic, extracranial and intracranial non-stenotic atherosclerotic plaques, collectively referred to as supracardiac atherosclerosis, appear as another significant potential source of embolism in ESUS

    .
    Recent studies have reported that non-stenotic complex intracranial atherosclerotic plaque (NICAP) is more common on the ipsilateral side of the infarction than on the opposite side, supporting the causal role of NICAP in ESUS

    .

    If AC and ipsilateral NICAP do have a causal relationship with ESUS, it can be assumed that there is a negative correlation between these two entities in the ESUS population, but there is no such negative correlation in other stroke populations, and these populations
    are causally related to the The entity has nothing to do, such as stroke patients caused by small vessel disease (SVD) .
    This article aims to evaluate (1) the correlation between AC and NICAP in ESUS patients and SVD patients, and (2) the performance of previously proposed biomarkers in identifying AC as a potential cause of ESUS

    .
    This article was published in the " Journal of Neurology, Neurosurgery & Psychiatry " ( Journal of Neurology, Neurosurgery & Psychiatry )
    .

    However, this negative correlation does not exist in other stroke populations, who have nothing to do with the entity in the etiology, such as stroke patients caused by small vessel disease (SVD)
    .
    This article aims to evaluate (1) the correlation between AC and NICAP in ESUS patients and SVD patients, and (2) the performance of previously proposed biomarkers in identifying AC as a potential cause of ESUS
    but not in other stroke populations.
    There is such a negative correlation, these people have nothing to do with the entity in the etiology, such as stroke patients caused by small vessel disease (SVD)

    .
    This article aims to evaluate (1) the correlation between AC and NICAP in ESUS patients and SVD patients, and (2) the performance of previously proposed biomarkers in identifying the potential cause of ESUS.
    This article was published in Neurology, on Neurosurgery and psychiatry "( Journal of Neurology, Neurosurgery & psychiatry )
    .
    This article was published in the " Journal of Neurology, Neurosurgery & Psychiatry " ( Journal of Neurology, Neurosurgery & Psychiatry )
    .
    This article was published in the " Journal of Neurology, Neurosurgery & Psychiatry " ( Journal of Neurology, Neurosurgery & Psychiatry )
    .

    403 subjects (243 ESU and 160 SVD) were included in the final analysis
    .
    All patients underwent intracranial HR-MRI to assess the presence of ipsilateral NICAP

    .
    Collect the biomarkers of AC within 24 hours after admission (ie P-wave terminal force (PTFV1) in lead V1 on the electrocardiogram, N-terminal probuline natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T And the diameter of the left atrium)

    .

    Increased PTFV1 and HR-MRI results in SVD and ESUS patients

    The results show that AC is more common in ESUS patients and SVD patients, further supporting the relationship between AC and ESUS
    .
    In addition, in ESUS patients, compared with ipsilateral NICAP patients, AC is more common in patients without iCAP.
    This finding is not obvious in SVD patients, which further supports the relationship between AC and atherosclerotic plaque in ESUS.
    The obvious relationship

    .
    In addition, after excluding iCAP patients, the performance of AC/AC-related biomarkers in distinguishing ESU from SVD was significantly improved

    .
    In addition, after excluding patients with AC/AC-related biomarkers, the ability of ipsilateral NICAP to distinguish ESU from SVD was significantly enhanced
    .
    In general, these results support the view that AC is an important cause of ESUS patients, rather than ipsilateral NICAP

    .
    In addition, the only biomarker of AC with the most information is PTFV1

    .

    In addition, after excluding patients with AC/AC-related biomarkers, the ability of ipsilateral NICAP to distinguish ESU from SVD was significantly enhanced
    .
    In general, these results support the view that AC is an important cause of ESUS patients, rather than ipsilateral NICAP

    .
    In addition, the only biomarker of AC with the most information is PTFV1

    .
    In addition, after excluding patients with AC/AC-related biomarkers, the ability of ipsilateral NICAP to distinguish ESU from SVD was significantly enhanced
    .
    In general, these results support the view that AC is an important cause of ESUS patients, rather than ipsilateral NICAP

    .
    In addition, the only biomarker of AC with the most information is PTFV1

    .

    In conclusion, AC is more common in patients with ESUS but not with iCAP compared with patients with iCAP, which means that AC and iCAP are two different causes of ESUS
    .
     

    Tao  L Dai  Y Shang  Z Tao  LTao Dai  YDai Shang  ZShang, et alAtrial cardiopathy and non-stenotic intracranial complicated atherosclerotic plaque in patients with embolic stroke of undetermined sourceJournal of Neurology, Neurosurgery & Psychiatry  Online First:  06 December 2021.
     
    Published Online First: doi:  10.
    1136/jnnp-2021-327517
    doi:

     



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