Kriptojenik inme hastalarında lezyon lokalizasyonu ile paroksismal atriyal fibrilasyon arasındaki ilişkinin araştırılması
Abstract
Amaç: Kriptojenik inme, standart vasküler, kardiyak veya serolojik değerlendirmeye rağmen kardiyoembolizm, büyük damar aterosklerozu veya küçük arter hastalığı gibi belli bir etiyolojiye kesin olarak bağlanamayan beyin enfarktüsü olarak tanımlanır. Hastaların yaklaşık üçte birini (%35) oluşturmaktadır. Patofizyolojisinde birçok olası mekanizma tanımlanmış olmasına rağmen daha çok kardiyak nedenler suçlanmıştır. Paroksismal atriyal fibrilasyon bu nedenlerden biridir. Internal karotis arter veya vertebral arterlerden kaynaklanan emboli tek sulama alanında enfarkt ile karşımıza çıkarken, kalp ya da asendan aortadan kaynaklanan emboli bazen bir, bazen birden fazla arter sulama alanında enfarkt ile karşımıza çıkabilmektedir. Buradan yola çıkarak çalışmamızda tek veya birden fazla sulama alanında enfarktı olan hastalarda, paroksismal atriyal fibrilasyon varlığı açısından fark olup olmadığını araştırdık. Yöntem: Bu amaçla, serebral dolaşımı üç ana alana ayırdık; sağ ön, sol ön ve arka dolaşım. Bu alanların herhangi ikisinde enfarktı olan hastaları multiple serebral enfarkt, tek alanda enfarktı olanları ise tek serebral alan enfarkt grubuna dahil ettik. Her iki gruba yaş ve cinsiyet dağılımı açısından benzerlik gösteren otuzar kriptojenik inme hastası aldık ve tüm hastalara 24 saat süre ile Holter elektrokardiyografi, 12 derivasyonlu elektrokardiyografi, transtorasik ekokardiyografi, beyin manyetik rezonans görüntüleme, bilgisayarlı tomografi ve/veya manyetik rezonans anjiografi uyguladık. Bulgular: Paroksismal atriyal fibrilasyon, multiple serebral enfarkt grubunda %26.7 (n=8) ve tek serebral alan enfarkt grubunda %20.0 (n=6) oranında gözlendi. Sonuç: Paroksismal atriyal fibrilasyon oranları açısından gruplar arasında anlamlı fark saptanmadı. (p=0.260) İstatiksel olarak gruplar arasında anlamlı fark olmaması hasta sayımızın az olmasından kaynaklanmış olabilir.
Supporting Institution
Herhangi bir kurum ya da kuruluş tarafından desteklenmemiştir.
Thanks
Holter EKG sonuçlarının değerlendirilmesine katkı sağlayan Prof. Dr. Ahmet Çamsarı’ya verdiği destekten dolayı teşekkür ederim.
References
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- 2. Saver JL. Clinical Practice. Cryptogenic Stroke. N Engl J Med 2016;374:2065
- 3. Sandercock P, Bamford J, Dennis M, Burn J: Atrial fibrillation and stroke: prevalence in different types of stroke and influence on early and long term prognosis (Oxfordshire community stroke project). BMJ 1992;12:305(6867):1460-5.
- 4. Hohnloser SH, Pajitnev D, Pogue J, et al. Incidence of stroke in paroxysmal versus sustained atrial fibrillation in patients taking oral anticoagulation or combined antiplatelet therapy: an ACTIVE W substudy. J Am Coll Cardiol. 2007;50:2156-2161.
- 5. Thakkar S, Bagarhatta R. Detection of paroxysmal atrial fibrillation or flutter in patients with acute ischemic stroke or transient ischemic attack by Holter monitoring. Indian heart J. 2014;66(2):188-92.
- 6. Chandra A, A Li W, Stone CR, Geng X, Ding Y. The cerebral circulation and the cerebrovascular disease I: Anatomy. Brain Circ. 2017;3(2):45-56.
- 7. Thomson R, Parkin D, M Eccles, M Sudlow, Robinson A. Decision analysis and guidelines for anticoagulant theraphy to prevent stroke in patients with atrial fibrillation. Lancet 2000;355(9208):956-962.
- 8. Hart RG, Halperin JL, Pearce LA, et al. Stroke prevention in atrial fibrillation investigators. Lessons from the stroke prevention in atrial fibrillation trials. Ann Intern Med. 2003;138:831-838. 9. Kamel H, Navi BB, Elijovich L, et al. Pilot randomized trial of outpatient cardiac monitoring after cryptogenic stroke. Stroke 2013;44:518-530.
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- 11. Gladstone DJ, Dorian P, Spring M, et al. Atrial premature beats predict atrial fibrillation in cryptogenic stroke: results from the EMBRACE trial. Stroke 2015; 46(4):936-41.
- 12. Roh JK, Kang DW, Lee SH, Yoon BW, Chang KH. Significance of acute multiple brain infarction on diffusion-weighted imaging. Stroke 2000;31:688-694.
- 13. Sposato LA, Riccio PM, Hachinski V. Post stroke atrial fibrillation: cause or consequence? Critical review of current views. Neurology 2014;82(13):1180.
- 14. Meissner I, Khandheria BK, Sheps SG, et al. Atherosclerosis of the aorta: risk factor, risk marker, or innocent by stander? A prospective population-based transesophageal echocardiography study. J Am Coll Cardiol. 2004;44:1018-1024.
- 15. Kannel WB, McGee DL. Diabetes and cardiovascular disease: the FraminghamStudy. JAMA. 1979;241:2035-2038.
Investigation of association of lesion localization and paroxysmal atrial fibrillation in cryptogenic stroke patients
Abstract
Aim: Cryptogenic stroke is defined as brain infarction that is not attributable to a source of definite cardioembolism, large vessel atherosclerosis or small artery disease despite a standart vascular, cardiac and serologic evaluation. Cryptogenic stroke constitutes about a third of patients (35%). Although many possible mechanisms have been described in its etiology, mostly cardiac sources have been accused. Paroxysmal atrial fibrillation is one of the causes. Embolism from the heart or ascending aorta sometimes can cause infarcts in single artery territory and sometimes in multiple artery territories, in contrast, embolism from internal carotid artery or vertebral arteries can cause infarcts in only one artery territory. In this study, we investigated whether there is a difference in the presence of paroxysmal atrial fibrillation in patients with infarcts in one or more territories. Method: For this purpose, we devided the cerebral circulation into 3 main territories; right front, left front and posterior circulation. We included patients with infarcts in any of these two territories into multiple cerebral infarction group and patients with infarcts in any of these territories into single cerebral infarction group. In both groups thirty patients with cryptogenic stroke who were similar in terms of age and gender distribution were included. 24-hour Holter eletrocardiography, 12-lead eletrocardiography, transthorasic echocardiography, brain magnetic resonance imaging, computed tomography and/or magnetic resonance angiography were performed to all patients. Results: Paroxysmal atrial fibrillation was detected 26.7% (n=8) in multiple cerebral infarction group and 20.0% (n=6) in single cerebral infarction group. Conclusion: There was no significant difference in paroxysmal atrial fibrillation incidence between the groups. (p=0.260) The absence of a statistically significant difference may be due to the small number of patients.
References
- 1. Benjamin EJ, Virani SS, Callaway CW, et al. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018.
- 2. Saver JL. Clinical Practice. Cryptogenic Stroke. N Engl J Med 2016;374:2065
- 3. Sandercock P, Bamford J, Dennis M, Burn J: Atrial fibrillation and stroke: prevalence in different types of stroke and influence on early and long term prognosis (Oxfordshire community stroke project). BMJ 1992;12:305(6867):1460-5.
- 4. Hohnloser SH, Pajitnev D, Pogue J, et al. Incidence of stroke in paroxysmal versus sustained atrial fibrillation in patients taking oral anticoagulation or combined antiplatelet therapy: an ACTIVE W substudy. J Am Coll Cardiol. 2007;50:2156-2161.
- 5. Thakkar S, Bagarhatta R. Detection of paroxysmal atrial fibrillation or flutter in patients with acute ischemic stroke or transient ischemic attack by Holter monitoring. Indian heart J. 2014;66(2):188-92.
- 6. Chandra A, A Li W, Stone CR, Geng X, Ding Y. The cerebral circulation and the cerebrovascular disease I: Anatomy. Brain Circ. 2017;3(2):45-56.
- 7. Thomson R, Parkin D, M Eccles, M Sudlow, Robinson A. Decision analysis and guidelines for anticoagulant theraphy to prevent stroke in patients with atrial fibrillation. Lancet 2000;355(9208):956-962.
- 8. Hart RG, Halperin JL, Pearce LA, et al. Stroke prevention in atrial fibrillation investigators. Lessons from the stroke prevention in atrial fibrillation trials. Ann Intern Med. 2003;138:831-838. 9. Kamel H, Navi BB, Elijovich L, et al. Pilot randomized trial of outpatient cardiac monitoring after cryptogenic stroke. Stroke 2013;44:518-530.
- 10. Liao J, Khalid Z, Scallan C, Morillo C, O’Donnell M. Noninvasive cardiac monitoring for detecting paroxysmal atrial fibrillation or flutter after acute ischemic stroke. A systematic review. Stroke 2007;38(11):2935-40.
- 11. Gladstone DJ, Dorian P, Spring M, et al. Atrial premature beats predict atrial fibrillation in cryptogenic stroke: results from the EMBRACE trial. Stroke 2015; 46(4):936-41.
- 12. Roh JK, Kang DW, Lee SH, Yoon BW, Chang KH. Significance of acute multiple brain infarction on diffusion-weighted imaging. Stroke 2000;31:688-694.
- 13. Sposato LA, Riccio PM, Hachinski V. Post stroke atrial fibrillation: cause or consequence? Critical review of current views. Neurology 2014;82(13):1180.
- 14. Meissner I, Khandheria BK, Sheps SG, et al. Atherosclerosis of the aorta: risk factor, risk marker, or innocent by stander? A prospective population-based transesophageal echocardiography study. J Am Coll Cardiol. 2004;44:1018-1024.
- 15. Kannel WB, McGee DL. Diabetes and cardiovascular disease: the FraminghamStudy. JAMA. 1979;241:2035-2038.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Articles |
| Authors | |
| Publication Date | December 15, 2021 |
| Submission Date | June 15, 2020 |
| Acceptance Date | June 15, 2021 |
| Published in Issue | Year 2021 Volume: 14 Issue: 3 |
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MEU Journal of Health Sciences Assoc was began to the publishing process in 2008 under the supervision of Assoc. Prof. Gönül Aslan, Editor-in-Chief, and affiliated to Mersin University Institute of Health Sciences. In March 2015, Prof. Dr. Caferi Tayyar Şaşmaz undertook the Editor-in Chief position and since then he has been in charge.
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