Introduction: Silent brain infarction (SBI) is an independent risk factor for subsequent symptomatic stroke in the general population. Although aortic stenosis (AS) is also known to be associated with an increased risk of future symptomatic stroke, little is known regarding the prevalence and risk factors for SBI in patients with AS. Methods: The study population comprised 83 patients with severe AS with no history of stroke or transient ischemic attack and paralysis or sensory impairment (mean age 75 ± 7 years). All patients underwent brain magnetic resonance imaging to screen for SBI and multidetector-row computed tomography to quantify the aortic valve calcification (AVC) volume. Comprehensive transthoracic and transesophageal echocardiography were performed to evaluate left atrial (LA) abnormalities, such as LA enlargement, spontaneous echo contrast, or abnormal LA appendage emptying velocity (#x3c;20 cm/s), and complex plaques in the aortic arch. Results: SBI was detected in 38 patients (46%). Multiple logistic regression analysis indicated that CHA₂DS₂-VASc score and estimated glomerular filtration rate (eGFR) were independently associated with SBI (p #x3c; 0.05), whereas LA abnormalities and AVC volume were not. When patients were divided into 4 groups according to CHA₂DS₂-VASc score and eGFR, the group with a higher CHA₂DS₂-VASc score (≥4) and a lower eGFR (#x3c;60 mL/min/1.73 m²) had a greater risk of SBI than the other groups (p #x3c; 0.05). Conclusion: These findings indicate that AS is associated with a high prevalence of SBI, and that the CHA₂DS₂-VASc score and eGFR are useful for risk stratification.
Cerebrovasc Dis Extra 2020;10:116–123

中文翻译：

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主动脉瓣狭窄患者脑梗死的患病率和危险因素

简介：静默性脑梗塞（SBI）是普通人群随后发生症状性中风的独立危险因素。尽管还已知主动脉瓣狭窄（AS）与未来症状性中风的风险增加有关，但对于AS患者中SBI的患病率和危险因素知之甚少。方法：研究人群包括83例重度AS患者，无中风或短暂性脑缺血发作，麻痹或感觉障碍（平均年龄75±7岁）。所有患者均接受脑磁共振成像以筛查SBI和多排行计算机断层扫描以量化主动脉瓣钙化（AVC）量。进行了全面的经胸和食道超声心动图检查，以评估左心房（LA）异常，例如LA增大，自发回声对比或异常LA附件排空速度（＃x3c; 20 cm / s），以及主动脉弓上的复杂斑块。结果： 38例患者中检出了SBI（46％）。多元逻辑回归分析表明CHA ₂ DS ₂-VASc评分和估计的肾小球滤过率（eGFR）与SBI独立相关（p＃x3c; 0.05），而LA异常和AVC量则无关。当患者根据CHA分为4组_2个DS ₂ -VASc得分和表皮生长因子受体，具有较高CHA的组_2个DS ₂ 60毫升/分钟/1.73米; -VASc得分（≥4）和下部的eGFR（＃X3C ²）的SBI风险比其他组高（p＃x3c; 0.05）。结论：这些发现表明AS与SBI的高发生有关，CHA ₂ DS ₂ -VASc评分和eGFR可用于危险分层。
Cerebrovasc Dis Extra 2020; 10：116–123