PDF(Pubmed)
Abstract：
UNASSIGNED: Cardioembolic stroke (CES) appears to be a rare cause of stroke (4%-9%) in people living with HIV (PLWH) in sub-Saharan Africa (SSA). However, due to limited access to diagnostic resources, this may be an underestimate. It is also unclear which cardiac pathologies are the major contributors to CES in this region. We sought to determine the prevalence and aetiology of CES in PLWH and to determine whether there are any differences compared with HIV negative stroke patients.
UNASSIGNED: This cross-sectional study recruited PLWH with new-onset stroke at a quaternary-level hospital in Johannesburg, South Africa, from 2014 to 2017, and compared them to age-matched and sex-matched HIV negative stroke patients. Comprehensive investigations were performed to determine the underlying stroke aetiology, including electrocardiography, echocardiography, CT angiography and cerebrospinal fluid examination.
UNASSIGNED: 85 PLWH with ischaemic stroke were recruited and compared with 109 HIV negative controls. CES was identified in 17/85 (20.0%) of PLWH. These patients had more severe strokes than PLWH with non-CES (National Institutes of Health Stroke Scale score 14.9±6.7 vs 11.7±5.4, p=0.04). Cardiomyopathy was the predominant cardiac pathology in PLWH (76.4% vs 45.5% in HIV negative, p=0.04) while valvulopathy was more common in HIV negative patients (42.4% vs 11.8% in PLWH, p=0.03). Arrhythmia (n=1) and ischaemic heart disease (n=1) were uncommon in PLWH.
UNASSIGNED: CES is underdiagnosed in SSA and is more severe than non-CES. The identification of cardiomyopathy as the predominant underlying cardiac pathology may assist to target resources towards its detection using accessible cost-effective biomarkers.
UNASSIGNED: This cross-sectional study recruited PLWH with new-onset stroke at a quaternary-level hospital in Johannesburg, South Africa, from 2014 to 2017, and compared them to age-matched and sex-matched HIV negative stroke patients. Comprehensive investigations were performed to determine the underlying stroke aetiology, including electrocardiography, echocardiography, CT angiography and cerebrospinal fluid examination.
UNASSIGNED: 85 PLWH with ischaemic stroke were recruited and compared with 109 HIV negative controls. CES was identified in 17/85 (20.0%) of PLWH. These patients had more severe strokes than PLWH with non-CES (National Institutes of Health Stroke Scale score 14.9±6.7 vs 11.7±5.4, p=0.04). Cardiomyopathy was the predominant cardiac pathology in PLWH (76.4% vs 45.5% in HIV negative, p=0.04) while valvulopathy was more common in HIV negative patients (42.4% vs 11.8% in PLWH, p=0.03). Arrhythmia (n=1) and ischaemic heart disease (n=1) were uncommon in PLWH.
UNASSIGNED: CES is underdiagnosed in SSA and is more severe than non-CES. The identification of cardiomyopathy as the predominant underlying cardiac pathology may assist to target resources towards its detection using accessible cost-effective biomarkers.
摘要：
■在撒哈拉以南非洲（SSA）的HIV感染者（PLWH）中，心源性卒中（CES）似乎是一种罕见的卒中原因（4%-9%）。然而,由于对诊断资源的访问有限，这可能是一个低估。还不清楚哪些心脏病是该地区CES的主要贡献者。我们试图确定CES在PLWH中的患病率和病因，并确定与HIV阴性卒中患者相比是否存在任何差异。
■这项横断面研究在约翰内斯堡的一家四级医院招募了患有新发中风的PLWH，南非,从2014年到2017年，并将其与年龄匹配和性别匹配的HIV阴性卒中患者进行比较。进行了综合调查以确定潜在的卒中病因，包括心电图,超声心动图,CT血管造影和脑脊液检查。
■纳入85PLWH伴缺血性卒中，并与109例HIV阴性对照进行比较。在PLWH的17/85(20.0%)中鉴定出CES。这些患者的中风比非CES的PLWH更严重（美国国立卫生研究院卒中量表评分14.9±6.7vs11.7±5.4，p=0.04）。心肌病是PLWH的主要心脏病理学（HIV阴性患者为76.4％vs45.5％，p=0.04），而瓣膜病变在HIV阴性患者中更为常见（PLWH中的42.4％vs11.8％，p=0.03)。心律失常（n=1）和缺血性心脏病（n=1）在PLWH中并不常见。
■CES在SSA中诊断不足，并且比非CES更严重。将心肌病鉴定为主要的潜在心脏病理学可能有助于使用可获得的具有成本效益的生物标志物将资源用于其检测。
■这项横断面研究在约翰内斯堡的一家四级医院招募了患有新发中风的PLWH，南非,从2014年到2017年，并将其与年龄匹配和性别匹配的HIV阴性卒中患者进行比较。进行了综合调查以确定潜在的卒中病因，包括心电图,超声心动图,CT血管造影和脑脊液检查。
■纳入85PLWH伴缺血性卒中，并与109例HIV阴性对照进行比较。在PLWH的17/85(20.0%)中鉴定出CES。这些患者的中风比非CES的PLWH更严重（美国国立卫生研究院卒中量表评分14.9±6.7vs11.7±5.4，p=0.04）。心肌病是PLWH的主要心脏病理学（HIV阴性患者为76.4％vs45.5％，p=0.04），而瓣膜病变在HIV阴性患者中更为常见（PLWH中的42.4％vs11.8％，p=0.03)。心律失常（n=1）和缺血性心脏病（n=1）在PLWH中并不常见。
■CES在SSA中诊断不足，并且比非CES更严重。将心肌病鉴定为主要的潜在心脏病理学可能有助于使用可获得的具有成本效益的生物标志物将资源用于其检测。
