Patricia de la Riva1, Maitane Zubikarai2, Cristina Sarasqueta3, Mikel Tainta4, Amaia Muñoz-Lopetegui5, Naiara Andrés-Marín5, Félix González5, Noemi Díez5, Ana de Arce5, Alberto Bergareche6, Adolfo Lopez de Munain7, Maite Martínez-Zabaleta8. 1. Department of Neurology, University Hospital Donostia, San Sebastián, Spain. Electronic address: patricia.delariva@gmail.com. 2. Faculty of Medicine, University of the Basque Country, Leioa, Spain. 3. Neurosciences Area, Biodonostia Institute, San Sebastián, Spain. 4. Department of Neurology, University Hospital Donostia, San Sebastián, Spain; CITA-Alzheimer Foundation, San Sebastian, Spain. 5. Department of Neurology, University Hospital Donostia, San Sebastián, Spain. 6. Department of Neurology, University Hospital Donostia, San Sebastián, Spain; Neurosciences Area, Biodonostia Institute, San Sebastián, Spain. 7. Department of Neurology, University Hospital Donostia, San Sebastián, Spain; Faculty of Medicine, University of the Basque Country, Leioa, Spain; Neurosciences Area, Biodonostia Institute, San Sebastián, Spain; Center for Biomedical Research in Neurodegenerative Diseases Network (CIBERNED), San Sebastián, Spain. 8. Department of Neurology, University Hospital Donostia, San Sebastián, Spain; Faculty of Medicine, University of the Basque Country, Leioa, Spain.
Abstract
OBJECTIVE: The aims of this study are, first, to calculate the risk of brain ischemia recurrence and embolic source diagnosis in the follow-up of patients with ESUS (embolic stroke of undetermined source) and, second, to identify the predictors of these events including cardiologic, laboratory, and clinical factors. METHODS: A retrospective observational cohort study of stroke patients admitted to the stroke unit in a single tertiary hospital from 2012 to 2014 was performed. Patients fulfilling ESUS criteria were identified and followed by medical history review until March 2016. Statistical analysis comprised Kaplan-Meier analysis and Cox proportional hazards multivariate analysis including clinical characteristics, cardiologic data, and blood test results. RESULTS: One hundred and thirteen patients, 8.3% of the overall stroke patients, filled ESUS criteria and they were younger, had less vascular risk factors, and suffered milder strokes than the remainder of stroke patients. Median follow-up of ESUS was 25.6 months. Risk of brain ischemia recurrence was 8.4, 10.8, and 15% at 12, 24, and 36 months, respectively, and was associated to age (HR 1.07, P = .027) and to a higher total cholesterol (TC)/high-density lipoprotein (HDL)-cholesterol (HR = 1.38, P = .002) and low-density lipoprotein (LDL)-cholesterol/HDL-cholesterol ratios (HR = 1.48, P = .001). The risk of major embolic source diagnosis was 6.7, 7.8, 13.6% at 12, 24, and 36 months, and was associated to female sex (HR = 6.05, P = .021). CONCLUSIONS: Brain ischemia recurrence increases with age and increased values of nontraditional lipid variables, TCHDLr and LDLHDLr, in ESUS patients, and women are more frequently diagnosed with a major embolic source in the follow-up.
OBJECTIVE: The aims of this study are, first, to calculate the risk of brain ischemia recurrence and embolic source diagnosis in the follow-up of patients with ESUS (embolic stroke of undetermined source) and, second, to identify the predictors of these events including cardiologic, laboratory, and clinical factors. METHODS: A retrospective observational cohort study of strokepatients admitted to the stroke unit in a single tertiary hospital from 2012 to 2014 was performed. Patients fulfilling ESUS criteria were identified and followed by medical history review until March 2016. Statistical analysis comprised Kaplan-Meier analysis and Cox proportional hazards multivariate analysis including clinical characteristics, cardiologic data, and blood test results. RESULTS: One hundred and thirteen patients, 8.3% of the overall strokepatients, filled ESUS criteria and they were younger, had less vascular risk factors, and suffered milder strokes than the remainder of strokepatients. Median follow-up of ESUS was 25.6 months. Risk of brain ischemia recurrence was 8.4, 10.8, and 15% at 12, 24, and 36 months, respectively, and was associated to age (HR 1.07, P = .027) and to a higher total cholesterol (TC)/high-density lipoprotein (HDL)-cholesterol (HR = 1.38, P = .002) and low-density lipoprotein (LDL)-cholesterol/HDL-cholesterol ratios (HR = 1.48, P = .001). The risk of major embolic source diagnosis was 6.7, 7.8, 13.6% at 12, 24, and 36 months, and was associated to female sex (HR = 6.05, P = .021). CONCLUSIONS:Brain ischemia recurrence increases with age and increased values of nontraditional lipid variables, TCHDLr and LDLHDLr, in ESUS patients, and women are more frequently diagnosed with a major embolic source in the follow-up.
Authors: Hans-Christoph Diener; J Donald Easton; Robert G Hart; Scott Kasner; Hooman Kamel; George Ntaios Journal: Nat Rev Neurol Date: 2022-05-10 Impact factor: 44.711