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Classification of Covert Brain Infarct Subtype and Risk of Death and Vascular Events.
Stroke ( IF 7.8 ) Pub Date : 2019-11-26 , DOI: 10.1161/strokeaha.119.026068 Jose Gutierrez 1 , Andrea Gil-Guevara 2 , Srinath Ramaswamy 1 , Janet DeRosa 1 , Marco R Di Tullio 3 , Ken Cheung 4 , Tatjana Rundek 5, 6, 7 , Ralph L Sacco 5, 6, 7 , Clinton B Wright 8 , Mitchell S V Elkind 1, 9
Stroke ( IF 7.8 ) Pub Date : 2019-11-26 , DOI: 10.1161/strokeaha.119.026068 Jose Gutierrez 1 , Andrea Gil-Guevara 2 , Srinath Ramaswamy 1 , Janet DeRosa 1 , Marco R Di Tullio 3 , Ken Cheung 4 , Tatjana Rundek 5, 6, 7 , Ralph L Sacco 5, 6, 7 , Clinton B Wright 8 , Mitchell S V Elkind 1, 9
Affiliation
Background and Purpose- To test the hypothesis that covert brain infarcts (CBIs) are more likely to be located in noneloquent brain areas compared with clinical strokes and that CBI etiological subtypes carry a differential risk of vascular events compared with people without CBI. Methods- We used brain magnetic resonance imaging from 1290 stroke-free participants in the NOMAS (Northern Manhattan Study) to evaluate for CBI. We classified CBI as cardioembolic (ie, known atrial fibrillation), large artery atherosclerosis (extracranial and intracranial), penetrating artery disease, and cryptogenic (no apparent cause). CBI localized in the nonmotor areas of the right hemisphere were considered noneloquent. We then evaluated risk of events by CBI subtype with adjusted Cox proportional models. Results- At the time of magnetic resonance imaging, 236 participants (18%) had CBI (144 [61%] distal cryptogenic, 29 [12%] distal cardioembolic, 26 [11%] large artery atherosclerosis, and 37 [16%] penetrating artery disease). Smaller (per mm, odds ratio, 0.8 [0.8-0.9]) and nonbrain stem infarcts (odds ratio, 0.2 [0.1-0.6]) were more likely to be covert. During the follow-up period (10.4±3.1 years), 398 (31%) died (162 [13%] of vascular death) and 117 (9%) had a stroke (99 [85%]) were ischemic. Risks of events varied by CBI subtype, with the highest risk of stroke (hazard ratio, 2.2 [1.3-3.7]) and vascular death (hazard ratio, 2.24 [1.29-3.88]) noted in participants with intracranial large artery atherosclerosis-related CBI. Conclusions- CBI can be classified into subtypes that have differential outcomes. Certain CBI subtypes such as those related to intracranial large artery atherosclerosis have a high risk of adverse vascular outcomes and could warrant consideration of treatment trials.
中文翻译：
隐性脑梗塞亚型的分类以及死亡和血管事件的风险。
背景与目的-为了检验以下假设：与临床卒中相比，隐性脑梗塞（CBI）更可能位于无言语的大脑区域，并且与没有CBI的人相比，CBI病因亚型具有不同的血管事件风险。方法-我们使用了来自NOMAS（北曼哈顿研究）的1290名无卒中参与者的脑磁共振成像来评估CBI。我们将CBI分为：心脏栓塞（即已知的房颤），大动脉粥样硬化（颅外和颅内），穿透性动脉疾病和隐源性（无明显原因）。位于右半球非运动区的CBI被认为是无言的。然后，我们使用调整后的Cox比例模型通过CBI亚型评估事件的风险。结果-在磁共振成像时，236名参与者（占18％）患有CBI（远端隐源性144 [61％]，心脏栓塞远端29 [12％]，大动脉粥样硬化26 [11％]和穿透性动脉疾病37 [16％]）。较小的（每毫米，优势比，0.8 [0.8-0.9]）和无脑梗塞（优势比，0.2 [0.1-0.6]）更可能是隐蔽的。在随访期间（10.4±3.1年），有398例（31％）死亡（占162例[13％]血管死亡），其中117例（9％）卒中（99例[85％]）是缺血性的。发生事件的风险因CBI亚型而异，在颅内大动脉粥样硬化相关CBI参与者中发现中风（危险比，2.2 [1.3-3.7]）和血管死亡（危险比，2.24 [1.29-3.88]）的风险最高。 。结论-CBI可以分为具有不同预后的亚型。
更新日期：2019-12-25
中文翻译：
隐性脑梗塞亚型的分类以及死亡和血管事件的风险。
背景与目的-为了检验以下假设：与临床卒中相比，隐性脑梗塞（CBI）更可能位于无言语的大脑区域，并且与没有CBI的人相比，CBI病因亚型具有不同的血管事件风险。方法-我们使用了来自NOMAS（北曼哈顿研究）的1290名无卒中参与者的脑磁共振成像来评估CBI。我们将CBI分为：心脏栓塞（即已知的房颤），大动脉粥样硬化（颅外和颅内），穿透性动脉疾病和隐源性（无明显原因）。位于右半球非运动区的CBI被认为是无言的。然后，我们使用调整后的Cox比例模型通过CBI亚型评估事件的风险。结果-在磁共振成像时，236名参与者（占18％）患有CBI（远端隐源性144 [61％]，心脏栓塞远端29 [12％]，大动脉粥样硬化26 [11％]和穿透性动脉疾病37 [16％]）。较小的（每毫米，优势比，0.8 [0.8-0.9]）和无脑梗塞（优势比，0.2 [0.1-0.6]）更可能是隐蔽的。在随访期间（10.4±3.1年），有398例（31％）死亡（占162例[13％]血管死亡），其中117例（9％）卒中（99例[85％]）是缺血性的。发生事件的风险因CBI亚型而异，在颅内大动脉粥样硬化相关CBI参与者中发现中风（危险比，2.2 [1.3-3.7]）和血管死亡（危险比，2.24 [1.29-3.88]）的风险最高。 。结论-CBI可以分为具有不同预后的亚型。
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