Stroke:心脏磁共振检测不明原因血栓型脑卒中患者左心血栓!

2017-08-19 xing.T MedSci原创

由此可见,当疑似ESUS患者存在心肌梗死或左心室功能障碍时,CE-CMR可能有助于提高心源性卒中的检测能力,并且可以为抗凝治疗提供相关的信息。

近日,卒中领域权威杂志Stroke上发表了一篇研究文章,研究人员旨在使用增强心脏磁共振(CE-CMR)成像检查来明确既往有心肌梗死或左室功能不全(左室射血分数[LVEF]<50%)的疑似不明原因血栓型脑卒中(ESUS)患者左心室(LV)血栓的患病率。

研究人员前瞻性的分析了2014年至2015年期间其所在医疗机构的797例急性缺血性脑卒中患者。心肌梗死或LVEF<50%的患者接受了CE-CMR成像检查。ESUS是基于经胸超声心动图的结果来进行诊断的。

研究人员发现在初步诊断中ESUS的患病率为22%(178/797)。在60例心肌梗死或LVEF<50%的患者中,脑卒中的亚型如下:小动脉疾病占17%(10/60);大动脉硬化占5%(3/60);心源性脑卒中占49%(29/60);ESUS占23%(14/60)以及除ESUS的不明原因占6%(4/60)。60例患者接受了CE-CMR检查,12例患者被确诊有LV血栓,而只有1例患者被胸超声心动图检测存在血栓(P=0.04)。重要的是,29%(4/14)的ESUS患者有左心室血栓。一个基于CE-CMR结果的预测模型显示在左室血栓检测方面具有较高的性能,在心源性脑卒中的分类上允许的净改善为0.46(95%可信区间为0.08-0.82;P=0.016)。与无左室血栓的患者相比,左室血栓患者LVEF较低(中位数为26% vs. 40%,P=0.003)。值得注意的是,42%(5/12)的LV血栓患者LVEF≥30%。

由此可见,当疑似ESUS患者存在心肌梗死或左心室功能障碍时,CE-CMR可能有助于提高心源性卒中的检测能力,并且可以为抗凝治疗提供相关的信息。

原始出处:

Junji Takasugi,et al. Detection of Left Ventricular Thrombus by Cardiac Magnetic Resonance in Embolic Stroke of Undetermined Source.Stroke. 2017. https://doi.org/10.1161/STROKEAHA.117.018263

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    2017-08-20 baihao215

    这个意义非凡呀,涨姿势了

    0

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    2017-08-19 ylzr123

    好文,值得点赞!认真学习了,把经验应用于实践,为患者解除病痛。

    0

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    2017-08-19 李东泽

    很好,不错,以后会多学习

    0