Kardioembolisks išēmisks insults gados jaunu pacientu grupā
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Date
2020
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Ievads. Pētnieciskais darbs „Kardioembolisks išēmisks insults gados jaunu pacientu grupā” apkopo datus par išēmisku insultu, kas skāris sociāli un ekonomiski aktīvu iedzīvotāju daļu – pacientus vecumā līdz 55 gadiem.
Mērķis. Noteikt kardioemboliska insulta biežumu un biežākos kardioembolijas avotus išēmiskam insultam gados jaunu pacientu grupā Rīgas Austrumu klīniskajā universitātes slimnīcā.
Metodes. Retrospektīvi tika analizēta medicīniskā dokumentācija par (n=277) pacientiem jaunākiem par 55 gadiem, kas laikā no 2017.gada janvāra līdz 2019.gada novembrim tika hospitalizēti Rīgas Austrumu klīniskajā universitātes slimnīcā ar diagnozi cerebrāls infarkts. Insulta etioloģija un kardioembolijas avoti tika noteikta balstoties uz Causative Classification of Ischemic Stroke klasifikāciju.
Rezultāti. Jaunu pacientu grupā vecumā līdz 55 gadiem 40,4% (n=112) gadījumos insulta cēloni noskaidrot neizdevās – neskaidras etioloģijas insults, biežākais no noskaidrotiem etiopatoģenētiskajiem insulta faktoriem ir kardioembolija – 23,1% (n=64), tad seko lielo asinsvadu ateroskleroze – 19,9% (n=55), sīko asinsvadu oklūzija – 11,2% (n=31) un visretāk ir sastopams citas noteiktas etioloģijas insults – 5,4% (n=15). Kardioembolisms saglabā vadošo lomu vecumā līdz 49 gadiem 23,0% (n=31), bet vecumā 50-55 gadiem biežākais insulta subtips ir lielo asinsvadu ateroskleroze 27,5% (n=39). Kardioemboliska cerebrālā infarkta grupā biežākais kardioembolijas avots ir permanentā ātriju fibrilācija 32,8% (n=21), tad seko persistējošā ovālā atvere 20,3% (n=13), dilatācijas kardiomiopātija, kreisā kambara hipertrofija 15,6% (n=10), mehāniskie sirds vārstuļi 7,8% (n=5), kreisā kambara trombs, ātriju starpsienas aneirisma ar persistējošo ovālo atveri – 4,7% (n=3), paroksismālā ātriju fibrilācija, nesens miokarda infarkts un kreisā kambara kontraktilitātes traucējumi – 3,1% (n=2), kreisā priekškambara trombs, kreisā kambara aneirisma bez tromba, sastrēguma sirds mazspēja ar izsviedes frakciju <30%, apikālā akinēzija un kambaru strapsienas aneirisma ir sastopamas visretāk – 1,6% (n=1). Pacientiem ≤49 gadiem vadošais kardioembolijas avots ir persistējošā ovālā atvere 41,9% (n=13) un ātriju fibrilāciju permanentu formu konstatē tikai 16,1% (n=5), savukārt, pacientiem vecumā >49 gadiem vadošais kardioembolijas avots ir ātriju fibrilācija permanentā forma 48,5% (n=16), un nevienam no pacientiem šai grupā persistējošo ovālo atveri nekonstatē. Visiem pacientiem ar persistējošo ovālo atveri pēc RoPE skalas novērtējums ir ≥ 7 punktiem, kas norāda par augstu varbūtību insulta saistībai ar patoloģiju.
Secinājumi. Pacientiem jaunākiem par 55 gadiem un pacientiem jaunākiem par 49 gadiem biežākais noteiktais cerebrālā infarkta subtips ir kardioembolisms. Pacientiem vecumā līdz 55 gadiem biežākais kardioembolijas avots ir ātriju fibrilācija, bet vecumā līdz 49 gadiem biežākais kardioembolijas avots ir persistējošā ovālā atvere.
Introduction. The research "Cardioembolic Ischemic Stroke in a Group of Young Patients" is a review of data on ischemic stroke affecting socially and economically active population of patients under the age of 55. Aim. To determine the frequency of cardioembolic strokes and the most common sources of cardioembolism in ischemic stroke in a group of younger patients at Riga Eastern Clinical University Hospital. Methods. A retrospective analysis of medical records of all (n=277) patients under the age of 55 hospitalized at the Riga Eastern Clinical University Hospital in the period from January 2017 to November 2019 with the diagnosis of cerebral infarction. The etiology of stroke and the sources of cardioembolism were determined on the basis of the Causative Classification of Ischemic Stroke. Results. In the population of younger patients under the age of 55 years, it is not possible to determine the cause of the stroke in 40.4% (n=112) of the cases - stroke of undetermined etiology. The most frequently reported etiopathogenic stroke factors are cardioaortic embolism - 23.1% (n=64), followed by supra-aortic large-artery atherosclerosis - 19.9% (n=55), small-artery occlusion - 11.2% (n=31), and the lowest incidence is stroke of other etiology (other uncommon causes) - 5.4% (n=15). Cardioaortic embolism retains the leading role in the age group under 49 years (23.0%) and in the age group of 50-55 the most frequent stroke subtype is supra-aortic large-artery atherosclerosis 27.5% (n = 39). In the cardioembolic cerebral infarction group, the most common source of cardioembolism is permanent atrial fibrillation 32.8% (n = 21), followed by patent foramen ovale 20.3% (n = 13), dilated cardiomyopathy, left ventricular hypertrophy 15.6% (n = 10), mechanical valves 7.8% (n = 5), left ventricular thrombus, atrial septal aneurysm with patent foramen ovale - 4.7% (n = 3), paroxysmal atrial fibrillation, recent myocardial infarction and left ventricular wall motion abnormalities - 3,1% (n = 2), left atrial thrombus, left ventricular aneurysm without thrombus, congestive heart failure with ejection fraction <30%, apical akinesia and ventricular septal aneurysm are the least frequent - 1.6%. In patients ≤49 years of age, the leading source of cardioembolism is patent foramen ovale 41.9% (n = 13) and atrial fibrillation is found in only 16.1% (n = 5), whereas in patients > 49 years of age, the leading source of cardioembolism is atrial fibrillation 48.5% (n = 16), and none of the patients in this group has a patent foramen ovale. All patients with patent foramen ovale have a RoPE score of ≥7, indicating a high likelihood of association between the stroke and the pathology. Conclusions. In patients younger than 55 and in patients younger than 49 the most common subtype of cerebral infarction is cardioembolism. In patients younger than 55 the most common source of cardioembolism is atrial fibrillation, while in the age group under 49 years - patent foramen ovale.
Introduction. The research "Cardioembolic Ischemic Stroke in a Group of Young Patients" is a review of data on ischemic stroke affecting socially and economically active population of patients under the age of 55. Aim. To determine the frequency of cardioembolic strokes and the most common sources of cardioembolism in ischemic stroke in a group of younger patients at Riga Eastern Clinical University Hospital. Methods. A retrospective analysis of medical records of all (n=277) patients under the age of 55 hospitalized at the Riga Eastern Clinical University Hospital in the period from January 2017 to November 2019 with the diagnosis of cerebral infarction. The etiology of stroke and the sources of cardioembolism were determined on the basis of the Causative Classification of Ischemic Stroke. Results. In the population of younger patients under the age of 55 years, it is not possible to determine the cause of the stroke in 40.4% (n=112) of the cases - stroke of undetermined etiology. The most frequently reported etiopathogenic stroke factors are cardioaortic embolism - 23.1% (n=64), followed by supra-aortic large-artery atherosclerosis - 19.9% (n=55), small-artery occlusion - 11.2% (n=31), and the lowest incidence is stroke of other etiology (other uncommon causes) - 5.4% (n=15). Cardioaortic embolism retains the leading role in the age group under 49 years (23.0%) and in the age group of 50-55 the most frequent stroke subtype is supra-aortic large-artery atherosclerosis 27.5% (n = 39). In the cardioembolic cerebral infarction group, the most common source of cardioembolism is permanent atrial fibrillation 32.8% (n = 21), followed by patent foramen ovale 20.3% (n = 13), dilated cardiomyopathy, left ventricular hypertrophy 15.6% (n = 10), mechanical valves 7.8% (n = 5), left ventricular thrombus, atrial septal aneurysm with patent foramen ovale - 4.7% (n = 3), paroxysmal atrial fibrillation, recent myocardial infarction and left ventricular wall motion abnormalities - 3,1% (n = 2), left atrial thrombus, left ventricular aneurysm without thrombus, congestive heart failure with ejection fraction <30%, apical akinesia and ventricular septal aneurysm are the least frequent - 1.6%. In patients ≤49 years of age, the leading source of cardioembolism is patent foramen ovale 41.9% (n = 13) and atrial fibrillation is found in only 16.1% (n = 5), whereas in patients > 49 years of age, the leading source of cardioembolism is atrial fibrillation 48.5% (n = 16), and none of the patients in this group has a patent foramen ovale. All patients with patent foramen ovale have a RoPE score of ≥7, indicating a high likelihood of association between the stroke and the pathology. Conclusions. In patients younger than 55 and in patients younger than 49 the most common subtype of cerebral infarction is cardioembolism. In patients younger than 55 the most common source of cardioembolism is atrial fibrillation, while in the age group under 49 years - patent foramen ovale.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Kardioembolisks insults, Cardioembolic stroke