Why the study?
What are the predictors of recurrent vascular events in patients with embolic stroke of undetermined source (ESUS) who undergo transesophageal echocardiography?
Cohort (n=177)
No
What are the predictors of recurrent vascular events in patients with embolic stroke of undetermined source (ESUS) who undergo transesophageal echocardiography?
Hazard Ratio: 2.29 (95% CI 1.11–4.72)
p-value: p=0.026
In patients with ESUS, diabetes and a higher CAM score (calcification in aortic arch, age, multiple infarctions) independently predict recurrent vascular events, highlighting the importance of comprehensive risk stratification.
潜因性脳梗塞の頻度は稀ではなく，その病態は多岐にわたる．潜因性脳梗塞はcryptogenic stroke として提言され，心エコー検査を主体とした塞栓源診断で卵円孔開存や弓部大動脈プラークの発症機序への関与が明らかにされてきた．特に，経食道心エコー（transthoracic echocardiography: TEE）は半侵襲的な検査であるが，これらの塞栓源の検出には有用である．近年では，潜因性脳梗塞に対してembolic stroke of undetermined source（ESUS）という新たな概念が提唱された．ESUS は診断の標準化という立場から，半侵襲的な検査であるTEE による塞栓源診断は必須ではない．しかし，逆説的にいえば，ESUS はTEE で診断される種々の塞栓源疾患が含まれる．我々は，ESUS の診断基準を満たしTEE を実施した症例を対象に，脳梗塞再発や心血管イベント発症の有無を後方視的に調査し，塞栓源疾患や臨床的特徴と予後の関連性を検討した．
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Ueno et al. (2017) conducted a cohort in Embolic stroke of undetermined source (ESUS) (n=177). CAM score (calcification in the aortic arch, age, multiple infarctions on MRI) vs. Lower CAM score was evaluated on Recurrent vascular events (RVE) (HR 2.29, 95% CI 1.11-4.72, p=0.026).
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