胸部X線を用いた左房径と脳性ナトリウム利尿ペプチド値の推測
「はじめに」心原性脳塞栓症は予後不良であることが知られており, 発症3カ月後のmodified Rankin Scale (mRS) が3～6となる確率はラクナ梗塞の約1.7倍とされている. しかし原因検索が不十分な脳梗塞は心原性脳塞栓症よりもさらに予後が不良であり, mRS 3～6はラクナ梗寒の約3.5倍まで増加する. 心原性脳塞栓症の最大の危険囚子は持続性/永続性心房細動 (atrial Fibrillation : AF) であるが, 発作性心房細動 (paroxysmal atrial fibrillation : PAF) も高リスク塞栓源心疾患であることが知られている. 実際, 塞...
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| Published in | Neurosonology Vol. 30; no. 2; pp. 38 - 42 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Kurashiki
一般社団法人日本脳神経超音波学会
2017
日本脳神経超音波学会 Japan Science and Technology Agency |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0917-074X 1884-3336 |
| DOI | 10.2301/neurosonology.30.38 |
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| Abstract | 「はじめに」心原性脳塞栓症は予後不良であることが知られており, 発症3カ月後のmodified Rankin Scale (mRS) が3～6となる確率はラクナ梗塞の約1.7倍とされている. しかし原因検索が不十分な脳梗塞は心原性脳塞栓症よりもさらに予後が不良であり, mRS 3～6はラクナ梗寒の約3.5倍まで増加する. 心原性脳塞栓症の最大の危険囚子は持続性/永続性心房細動 (atrial Fibrillation : AF) であるが, 発作性心房細動 (paroxysmal atrial fibrillation : PAF) も高リスク塞栓源心疾患であることが知られている. 実際, 塞栓源不明の脳塞栓症275例を対象にした検討では, 脳卒中再発時にAFが存在していた例11.0%, 経過観察中にAFが発見された例18.3%, AFが強く疑われた例13.9%であり, 塞栓源不明の脳塞栓症の約3割でAFによる機序が考えられた. |
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| AbstractList | 「はじめに」心原性脳塞栓症は予後不良であることが知られており, 発症3カ月後のmodified Rankin Scale (mRS) が3～6となる確率はラクナ梗塞の約1.7倍とされている. しかし原因検索が不十分な脳梗塞は心原性脳塞栓症よりもさらに予後が不良であり, mRS 3～6はラクナ梗寒の約3.5倍まで増加する. 心原性脳塞栓症の最大の危険囚子は持続性/永続性心房細動 (atrial Fibrillation : AF) であるが, 発作性心房細動 (paroxysmal atrial fibrillation : PAF) も高リスク塞栓源心疾患であることが知られている. 実際, 塞栓源不明の脳塞栓症275例を対象にした検討では, 脳卒中再発時にAFが存在していた例11.0%, 経過観察中にAFが発見された例18.3%, AFが強く疑われた例13.9%であり, 塞栓源不明の脳塞栓症の約3割でAFによる機序が考えられた. Objective: Detection of paroxysmal atrial fibrillation (PAF) in patients with acute stroke is often difficult. Dilatation of left atrium dimension (LAD) and increased levels of brain natriuretic peptide (BNP) are reported to indicate cerebral embolism due to PAF. We assessed the usefulness of chest X-ray in predicting LAD and BNP among patients with acute cerebral infarction. Methods: We included 141 consecutive patients with cerebral infarction [107 cerebral thromboses (cerebral thrombosis group)] and 34 cardiogenic cerebral embolisms due to PAF (PAF group). Transthoracic echocardiography (TTE) was used to evaluate LAD (TTE-LA). On chest X-ray, heart diameter at the third aortic arch (XP-LA) and XP-LA divided by maximum intrathoracic diameter (XP-LA ratio) were measured. Results: TTE-LA, XP-LA, XP-LA ratio and BNP levels were significantly higher in PAF group compared with those in cerebral thrombosis group. XP-LA had a significant positive correlation with TTE-LA (r = 0.332, p < 0.0001) and BNP (r = 0.292, p < 0.001). XP-LA ratio also showed a significant correlation with TTE-LA (r = 0.210, p = 0.0126) and BNP (r = 0.515, p < 0.0001). Conclusion: We suggest chest X-ray is a simple and useful tool for predicting LAD and BNP. |
| Author | 鈴木, 圭輔 岩崎, 晶夫 五十嵐, 晴紀 岡部, 龍太 平田, 幸一 塚原, 由佳 飯塚, 賢太郎 豊田, 茂 竹川, 英宏 鈴木, 綾乃 |
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| References | 4)Higgins P, MacFarlane PW, Dawson J, et al.: Noninvasive cardiac event monitoring to detect atrial fibrillation after ischemic stroke: a randomized, controlled trial. Stroke 2013; 44: 2525-2531. 10)Yoshioka K, Watanabe K, Zeniya S, et al.: A Score for Predicting Paroxysmal Atrial Fibrillation in Acute Stroke Patients: iPAB Score. J Stroke Cerebrovasc Dis 2015; 24: 2263-2269. 5)Llombart V, Antolin-Fontes A, Bustamante A, et al.: B-type natriuretic peptides help in cardioembolic stroke diagnosis: pooled data meta-analysis. Stroke 2015; 46: 1187-1195. 6)Hoshino T, Nagao T, Shiga T, et al.: Prolonged QTc interval predicts poststroke paroxysmal atrial fibrillation. Stroke 2015; 46: 71-76. 12)Sanfilippo AJ, Abascal VM, Sheehan M, et al.: Atrial enlargement as a consequence of atrial fibrillation. A prospective echocardiographic study. Circulation 1990; 82: 792-797. 1)Nam HS, Kim HC, Kim YD, et al.: Long-term mortality in patients with stroke of undetermined etiology. Stroke 2012; 43: 2948-2956. 16)Hasegawa K, Fujiwara H, Doyama K, et al.: Ventricular expression of brain natriuretic peptide in hypertrophic cardiomyopathy. Circulation 1993; 88: 372-380. 15)Calzetta L, Orlandi A, Page C, et al.: Brain natriuretic peptide: Much more than a biomarker. Int J Cardiol 2016; 221: 1031-1038. 9)Fujii S, Shibazaki K, Kimura K, et al.: A simple score for predicting paroxysmal atrial fibrillation in acute ischemic stroke. J Neurol Sci 2013; 328: 83-86. 2)Ay H, Furie KL, Singhal A, et al.: An evidence-based causative classification system for acute ischemic stroke. Ann Neurol 58: 688-697, 2005. 14)Yaghi S, Moon YP, Mora-McLaughlin C, et al.: Left atrial enlargement and stroke recurrence: the Northern Manhattan Stroke Study. Stroke 2015; 46: 1488-1493. 8)Kamel H, Hunter M, Moon YP, et al.: Electrocardiographic Left Atrial Abnormality and Risk of Stroke: Northern Manhattan Study. Stroke 2015; 46: 3208-3212. 3)Ntaios G, Papavasileiou V, Milionis H, et al.: Embolic strokes of undetermined source in the Athens stroke registry: a descriptive analysis. Stroke 2015; 46: 176-181. 11)Loomba RS, Shah PH, Nijhawan K, et al.: Cardiothoracic ratio for prediction of left ventricular dilation: a systematic review and pooled analysis. Future Cardiol 2015; 11: 171-175. 7)Healey JS, Connolly SJ, Gold MR, et al.: Subclinical atrial fibrillation and the risk of stroke. N Engl J Med 2012; 366: 120-129. 13)Wijffels MC, Kirchhof CJ, Dorland R, et al.: Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation 1995; 92: 1954-1968. |
| References_xml | – reference: 2)Ay H, Furie KL, Singhal A, et al.: An evidence-based causative classification system for acute ischemic stroke. Ann Neurol 58: 688-697, 2005. – reference: 5)Llombart V, Antolin-Fontes A, Bustamante A, et al.: B-type natriuretic peptides help in cardioembolic stroke diagnosis: pooled data meta-analysis. Stroke 2015; 46: 1187-1195. – reference: 14)Yaghi S, Moon YP, Mora-McLaughlin C, et al.: Left atrial enlargement and stroke recurrence: the Northern Manhattan Stroke Study. Stroke 2015; 46: 1488-1493. – reference: 13)Wijffels MC, Kirchhof CJ, Dorland R, et al.: Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation 1995; 92: 1954-1968. – reference: 3)Ntaios G, Papavasileiou V, Milionis H, et al.: Embolic strokes of undetermined source in the Athens stroke registry: a descriptive analysis. Stroke 2015; 46: 176-181. – reference: 6)Hoshino T, Nagao T, Shiga T, et al.: Prolonged QTc interval predicts poststroke paroxysmal atrial fibrillation. Stroke 2015; 46: 71-76. – reference: 10)Yoshioka K, Watanabe K, Zeniya S, et al.: A Score for Predicting Paroxysmal Atrial Fibrillation in Acute Stroke Patients: iPAB Score. J Stroke Cerebrovasc Dis 2015; 24: 2263-2269. – reference: 16)Hasegawa K, Fujiwara H, Doyama K, et al.: Ventricular expression of brain natriuretic peptide in hypertrophic cardiomyopathy. Circulation 1993; 88: 372-380. – reference: 9)Fujii S, Shibazaki K, Kimura K, et al.: A simple score for predicting paroxysmal atrial fibrillation in acute ischemic stroke. J Neurol Sci 2013; 328: 83-86. – reference: 4)Higgins P, MacFarlane PW, Dawson J, et al.: Noninvasive cardiac event monitoring to detect atrial fibrillation after ischemic stroke: a randomized, controlled trial. Stroke 2013; 44: 2525-2531. – reference: 11)Loomba RS, Shah PH, Nijhawan K, et al.: Cardiothoracic ratio for prediction of left ventricular dilation: a systematic review and pooled analysis. Future Cardiol 2015; 11: 171-175. – reference: 1)Nam HS, Kim HC, Kim YD, et al.: Long-term mortality in patients with stroke of undetermined etiology. Stroke 2012; 43: 2948-2956. – reference: 7)Healey JS, Connolly SJ, Gold MR, et al.: Subclinical atrial fibrillation and the risk of stroke. N Engl J Med 2012; 366: 120-129. – reference: 8)Kamel H, Hunter M, Moon YP, et al.: Electrocardiographic Left Atrial Abnormality and Risk of Stroke: Northern Manhattan Study. Stroke 2015; 46: 3208-3212. – reference: 15)Calzetta L, Orlandi A, Page C, et al.: Brain natriuretic peptide: Much more than a biomarker. Int J Cardiol 2016; 221: 1031-1038. – reference: 12)Sanfilippo AJ, Abascal VM, Sheehan M, et al.: Atrial enlargement as a consequence of atrial fibrillation. A prospective echocardiographic study. Circulation 1990; 82: 792-797. |
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| Snippet | 「はじめに」心原性脳塞栓症は予後不良であることが知られており, 発症3カ月後のmodified Rankin Scale (mRS) が3～6となる確率はラクナ梗塞の約1.7倍とされている. しかし原因検索が不十分な脳梗塞は心原性脳塞栓症よりもさらに予後が不良であり, mRS... Objective: Detection of paroxysmal atrial fibrillation (PAF) in patients with acute stroke is often difficult. Dilatation of left atrium dimension (LAD) and... |
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| SubjectTerms | Brain cardiogenic cerebral embolism Chest chest X-ray Echocardiography Embolisms Fibrillation Heart Infarction left atrium dimension paroxysmal atrial fibrillation Patients Thrombosis transthoracic echocardiography |
| Title | 胸部X線を用いた左房径と脳性ナトリウム利尿ペプチド値の推測 |
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