JAHA:卒中患者心壁运动异常与主要不良心血管事件的关联

2021-07-14 MedSci原创 MedSci原创

CWMA与MACE风险增加1.7倍相关,独立于已明确的危险因素。来源不明的栓塞性卒中是与CWMA相关最常见的卒中类型。

卒中患者心脏壁运动异常(CWMA)与主要不良血管事件(MACE)之间的关联仍未明确。

近日,心血管疾病领域权威杂志JAHA上发表了一篇研究文章,该研究旨在评估伴有CWMA的卒中患者50个月内的MACE风险,包括卒中复发、急性冠脉事件和血管性死亡。

研究人员对前瞻性收集的急性卒中数据(急性卒中和短暂性脑缺血发作)进行了回顾性分析。数据包括人口统计学指标和临床​​信息、血管成像和超声心动图数据,包括CWMA和MACE。

Kaplan-Meier曲线

在2653名急性卒中/短暂性脑缺血发作患者中,355名(13.4%)患者观察到了CWMA。在CWMA患者中,来源不明的栓塞性卒中(50.7%)是最常见的卒中亚型(P=0.001)。在调整人口统计学指标、传统风险和混杂因素后的多变量Cox回归中,CWMA与较高的MACE风险独立相关(调整后的风险比[aHR]为1.74;95%CI为1.37–2.21[P=0.001])。与没有CWMA的卒中患者相比,CWMA独立地增加了缺血性卒中复发的风险(aHR为1.50;95%CI为1.01-2.17[P=0.04]),增加了急性冠状动脉事件(aHR为2.50;95%CI为1.83-3.40[P=0.001])和血管性死亡(aHR为1.57;95%CI为1.04-2.40[P=0.03])的风险。

在这个伴有CWMA的缺血性卒中患者的多民族队列中,CWMA与MACE风险增加1.7倍相关,独立于已明确的危险因素。来源不明的栓塞性卒中是与CWMA相关最常见的卒中类型。卒中患者应进行CWMA筛查,以识别发生MACE风险较高的患者。
 
原始出处:

Saadat Kamran.et al.Association of Major Adverse Cardiovascular Events in Patients With Stroke and Cardiac Wall Motion Abnormalities.J AM HEART ASSOC.2021.https://www.ahajournals.org/doi/10.1161/JAHA.121.020888

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    2021-12-12 gous
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    2021-07-16 zhaohui6731
  5. [GetPortalCommentsPageByObjectIdResponse(id=1813911, encodeId=9a321813911e7, content=<a href='/topic/show?id=101f9416466' target=_blank style='color:#2F92EE;'>#运动异常#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94164, encryptionId=101f9416466, topicName=运动异常)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7a9987, createdName=gous, createdTime=Sun Dec 12 16:25:27 CST 2021, time=2021-12-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1720401, encodeId=2c2e1e204017f, content=<a href='/topic/show?id=915c3604e6b' target=_blank style='color:#2F92EE;'>#卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36047, encryptionId=915c3604e6b, topicName=卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=940232842333, createdName=wangyang7969, createdTime=Wed Jul 21 01:25:27 CST 2021, time=2021-07-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1643753, encodeId=1d631643e53f7, content=<a href='/topic/show?id=6236895092b' target=_blank style='color:#2F92EE;'>#血管事件#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89509, encryptionId=6236895092b, topicName=血管事件)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f99523187183, createdName=hukaixun, createdTime=Thu Dec 09 00:25:27 CST 2021, time=2021-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1268579, encodeId=757012685e97f, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Fri Jul 16 13:25:27 CST 2021, time=2021-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1533206, encodeId=0fdc1533206b1, content=<a href='/topic/show?id=c7a02326657' target=_blank style='color:#2F92EE;'>#主要不良心血管事件#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23266, encryptionId=c7a02326657, topicName=主要不良心血管事件)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=929a12392280, createdName=wetgdt, createdTime=Fri Jul 16 13:25:27 CST 2021, time=2021-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026910, encodeId=277010269105e, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Thu Jul 15 01:25:27 CST 2021, time=2021-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999593, encodeId=1aa699959398, content=关注医疗, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210313/9df56058b3964a8cac82563f95f0389d/c1b478592e8e4463bef44d32712e98fd.jpg, createdBy=ea905324251, createdName=SR~young海东, createdTime=Wed Jul 14 23:20:51 CST 2021, time=2021-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999585, encodeId=452a99958564, content=,,啊啊啊啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0ccf5537117, createdName=ms7000001309583260, createdTime=Wed Jul 14 22:55:22 CST 2021, time=2021-07-14, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1813911, encodeId=9a321813911e7, content=<a href='/topic/show?id=101f9416466' target=_blank style='color:#2F92EE;'>#运动异常#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94164, encryptionId=101f9416466, topicName=运动异常)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7a9987, createdName=gous, createdTime=Sun Dec 12 16:25:27 CST 2021, time=2021-12-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1720401, encodeId=2c2e1e204017f, content=<a href='/topic/show?id=915c3604e6b' target=_blank style='color:#2F92EE;'>#卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36047, encryptionId=915c3604e6b, topicName=卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=940232842333, createdName=wangyang7969, createdTime=Wed Jul 21 01:25:27 CST 2021, time=2021-07-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1643753, encodeId=1d631643e53f7, content=<a href='/topic/show?id=6236895092b' target=_blank style='color:#2F92EE;'>#血管事件#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89509, encryptionId=6236895092b, topicName=血管事件)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f99523187183, createdName=hukaixun, createdTime=Thu Dec 09 00:25:27 CST 2021, time=2021-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1268579, encodeId=757012685e97f, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Fri Jul 16 13:25:27 CST 2021, time=2021-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1533206, encodeId=0fdc1533206b1, content=<a href='/topic/show?id=c7a02326657' target=_blank style='color:#2F92EE;'>#主要不良心血管事件#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23266, encryptionId=c7a02326657, topicName=主要不良心血管事件)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=929a12392280, createdName=wetgdt, createdTime=Fri Jul 16 13:25:27 CST 2021, time=2021-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026910, encodeId=277010269105e, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Thu Jul 15 01:25:27 CST 2021, time=2021-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999593, encodeId=1aa699959398, content=关注医疗, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210313/9df56058b3964a8cac82563f95f0389d/c1b478592e8e4463bef44d32712e98fd.jpg, createdBy=ea905324251, createdName=SR~young海东, createdTime=Wed Jul 14 23:20:51 CST 2021, time=2021-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999585, encodeId=452a99958564, content=,,啊啊啊啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0ccf5537117, createdName=ms7000001309583260, createdTime=Wed Jul 14 22:55:22 CST 2021, time=2021-07-14, status=1, ipAttribution=)]
    2021-07-15 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1813911, encodeId=9a321813911e7, content=<a href='/topic/show?id=101f9416466' target=_blank style='color:#2F92EE;'>#运动异常#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94164, encryptionId=101f9416466, topicName=运动异常)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7a9987, createdName=gous, createdTime=Sun Dec 12 16:25:27 CST 2021, time=2021-12-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1720401, encodeId=2c2e1e204017f, content=<a href='/topic/show?id=915c3604e6b' target=_blank style='color:#2F92EE;'>#卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36047, encryptionId=915c3604e6b, topicName=卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=940232842333, createdName=wangyang7969, createdTime=Wed Jul 21 01:25:27 CST 2021, time=2021-07-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1643753, encodeId=1d631643e53f7, content=<a href='/topic/show?id=6236895092b' target=_blank style='color:#2F92EE;'>#血管事件#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89509, encryptionId=6236895092b, topicName=血管事件)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f99523187183, createdName=hukaixun, createdTime=Thu Dec 09 00:25:27 CST 2021, time=2021-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1268579, encodeId=757012685e97f, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Fri Jul 16 13:25:27 CST 2021, time=2021-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1533206, encodeId=0fdc1533206b1, content=<a href='/topic/show?id=c7a02326657' target=_blank style='color:#2F92EE;'>#主要不良心血管事件#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23266, encryptionId=c7a02326657, topicName=主要不良心血管事件)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=929a12392280, createdName=wetgdt, createdTime=Fri Jul 16 13:25:27 CST 2021, time=2021-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026910, encodeId=277010269105e, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Thu Jul 15 01:25:27 CST 2021, time=2021-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999593, encodeId=1aa699959398, content=关注医疗, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210313/9df56058b3964a8cac82563f95f0389d/c1b478592e8e4463bef44d32712e98fd.jpg, createdBy=ea905324251, createdName=SR~young海东, createdTime=Wed Jul 14 23:20:51 CST 2021, time=2021-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999585, encodeId=452a99958564, content=,,啊啊啊啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0ccf5537117, createdName=ms7000001309583260, createdTime=Wed Jul 14 22:55:22 CST 2021, time=2021-07-14, status=1, ipAttribution=)]
    2021-07-14 SR~young海东

    关注医疗

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1813911, encodeId=9a321813911e7, content=<a href='/topic/show?id=101f9416466' target=_blank style='color:#2F92EE;'>#运动异常#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94164, encryptionId=101f9416466, topicName=运动异常)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7a9987, createdName=gous, createdTime=Sun Dec 12 16:25:27 CST 2021, time=2021-12-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1720401, encodeId=2c2e1e204017f, content=<a href='/topic/show?id=915c3604e6b' target=_blank style='color:#2F92EE;'>#卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36047, encryptionId=915c3604e6b, topicName=卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=940232842333, createdName=wangyang7969, createdTime=Wed Jul 21 01:25:27 CST 2021, time=2021-07-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1643753, encodeId=1d631643e53f7, content=<a href='/topic/show?id=6236895092b' target=_blank style='color:#2F92EE;'>#血管事件#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89509, encryptionId=6236895092b, topicName=血管事件)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f99523187183, createdName=hukaixun, createdTime=Thu Dec 09 00:25:27 CST 2021, time=2021-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1268579, encodeId=757012685e97f, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Fri Jul 16 13:25:27 CST 2021, time=2021-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1533206, encodeId=0fdc1533206b1, content=<a href='/topic/show?id=c7a02326657' target=_blank style='color:#2F92EE;'>#主要不良心血管事件#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23266, encryptionId=c7a02326657, topicName=主要不良心血管事件)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=929a12392280, createdName=wetgdt, createdTime=Fri Jul 16 13:25:27 CST 2021, time=2021-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026910, encodeId=277010269105e, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Thu Jul 15 01:25:27 CST 2021, time=2021-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999593, encodeId=1aa699959398, content=关注医疗, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210313/9df56058b3964a8cac82563f95f0389d/c1b478592e8e4463bef44d32712e98fd.jpg, createdBy=ea905324251, createdName=SR~young海东, createdTime=Wed Jul 14 23:20:51 CST 2021, time=2021-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999585, encodeId=452a99958564, content=,,啊啊啊啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0ccf5537117, createdName=ms7000001309583260, createdTime=Wed Jul 14 22:55:22 CST 2021, time=2021-07-14, status=1, ipAttribution=)]
    2021-07-14 ms7000001309583260

    ,,啊啊啊啊

    0

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Stroke:早产成人的卒中风险

在这个大型全国队列中,早产与成年期出血性和缺血性卒中的风险增加有关。早产幸存者需要早期预防性评估和长期临床随访,以降低他们终生的卒中风险

Stroke:卒中和痴呆的长期发病率

与基于阿替洛尔的降压方案相比,基于氨氯地平的降压方案降低了卒中的长期发病率,但对痴呆症没有可显著的影响。阿托伐他汀对卒中或痴呆症均无效应。较高的血压变异性与较高的后期痴呆和卒中发生率相关。

Neurology:卒中患者合并肾功能不全,强化降压治疗可能适得其反!

卒中和慢性肾病都是相当棘手的疾病,当同时患有这两类疾病时,治疗上更是难上加难。

JAHA:左房应变可预测窦性心律的急性心衰患者卒中风险

在伴有窦性心律的急性HF患者中,LAGLS降低(<14.5%)与卒中风险增加相关,其年发病率为2.38%。

JAHA:血液透析患者使用促红细胞生成素治疗与卒中风险

接受血液透析的患者采用促红细胞生成素治疗与卒中或其任何亚型卒中的风险增加无关。

Stroke:接受选择性血清素再摄取抑制剂治疗的卒中患者骨折风险如何?

根据氟西汀和西酞普兰的现有RCT,使用6个月的SSRI使卒中幸存者的骨折风险增加了一倍。