| Objective:Cardiovascular events are common clinical complications in patients with ischemic stroke(IS),but the exact mechanism IS still unclear.The purpose of this study was to investigate the risk factors of cardiovascular events and their relationship with plasma brain natriuretic peptide(BNP)levels in patients with ischemic stroke through retrospective study.Methods:A retrospective study was conducted to analyze the patients admitted to the Department of Neurology,Affiliated Hospital of Qingdao University from January 2019 to January 2020,who were initially diagnosed as IS by MRI examination in our hospital,and who had not been previously diagnosed with cardiovascular disease and had completed brain natriuretic peptide examination.Past circulatory diseases such as atrial fibrillation,rheumatic heart disease,valvular disease,atrioventricular septal defect,and patent foramen ovale were excluded;Previous neurological diseases,such as stenosis,dilation,rupture and other lesions of blood vessels supplied by brain tissue,such as cerebral hemorrhage and moyamoya disease,were excluded;Previous history of other diseases,such as autoimmune disease,vasculitis,platelet abnormalities,and non-benign space-occupying lesions were excluded.The incidence of cardiovascular adverse events during the first 6 months following the onset of IS was tracked.We defined cardiovascular adverse events as myocardial ischemia due to coronary stenosis and ischemia-related congestive heart failure or cardiovascular death.Use statistical methods to analyze the risk of cardiovascular adverse incident ischemic stroke group,according to the results of the auxiliary examination magnetic resonance(NMR)IS divided into large vascular lesions stroke group and small vascular lesions stroke and unexplained stroke group,compared three groups of patients with cardiovascular adverse events happen within 6 month,so as to explore IS predictor of cardiovascular events.Results:1.In this study,a total of 317 patients were screened through exclusion criteria.All patients were followed up for 6 months,39 cases were lost to follow-up and 278 cases were effectively followed up.There were 155 males(55.76%)with a median age of 62years(37-87 years).The final adverse cardiovascular events occurred in 29 patients(10.43%,29/278),including coronary artery disease in 17 patients,angina pectoris in 8patients,myocardial infarction in 3 patients,cardiac insufficiency and death in 1 patient.2.According to the incidence of adverse cardiovascular events within 6 months after stroke,278 patients with effective follow-up were divided into cardiovascular event group and non-cardiovascular event group.There were 29 patients in the cardiovascular event group,including 21 males(72.41%),median age 61 years(39-83 years),history of smoking 37.93%(11/29),history of drinking 41.38%(12/29),history of hypertension58.62%(17/29),diabetes 24.14%(7/29),history of smoking 41.38%(12/29),history of hypertension 58.62%(17/29),history of diabetes 24.14%(7/29).Mean TG(1.72±0.82)mmol/L,Mean TC(4.78±1.23)mmol/L,Mean LDL-C(2.72±1.00)mmol/L,Mean TG(1.72±0.82)mmol/L,Mean TC(4.78±1.23)mmol/L,Mean LDL-C(2.72±1.00)mmol/LThe mean HDL-C level was(1.22±0.28)mmol/L,and the mean plasma BNP level was(329.80±97.25)pg/mL.In the non-cardiovascular event group,there were 249 cases,including 181 males(72.69%),median age 59 years(36--87 years),history of smoking42.57%(106/249),history of drinking 38.15%(95/249),and history of hypertension73.90%(184/249).Diabetes mellitus accounted for 36.95%(92/249),average TG(1.51±0.86)mmol/L,average TC(4.48±1.21)mmol/L,average LDL-C(2.71±0.90)mmol/L,average HDL-C(1.28±0.36)mmol/L,The mean plasma BNP level was(65.92±34.85)pg/mL.Common risk markers for cardiovascular events and plasma BNP levels were compared between the two groups: only plasma BNP levels were statistically significant(P <0.05).We used the ROC curve to further analyze the best threshold for predicting the occurrence of cardiovascular adverse events by the plasma BNP level in stroke patients.The results found that: the plasma BNP level in stroke patients was185.75pg/mL to predict the occurrence of cardiovascular adverse events after stroke It has a certain accuracy,the area under the curve is 0.761,the 95% CI is(0.673-0.879),the prediction sensitivity is 73.1%,and the specificity is 76.9%.3.Of the 278 patients who were effectively followed up,26 had no DSA or MRA or CTA to assess the intracranial arteries,so 252 patients were included,and 26 had adverse cardiovascular events within 6 months in the IS patients.A total of 252 patients evaluated by craniocerebral artery were divided into three groups: large vessel pathogen-induced ischemic stroke group,small vessel pathogen-induced ischemic stroke group,and unknown cause ischemic stroke group.In the macrovascular disease stroke group of 84 patients,14 patients had adverse cardiovascular events within 6 months after stroke,and the incidence of adverse cardiovascular events was 16.67%(14/84).Among the 92 patients in the small vessel lesion stroke group,8 patients had adverse cardiovascular events within 6 months after stroke,and the incidence of adverse cardiovascular events was 8.70%(8/92).Among 86 patients with unexplained ischemic stroke,4 patients had adverse cardiovascular events within 6 months after stroke,and the incidence rate of adverse cardiovascular events was 4.65%(4/86).A statistical comparison of the incidence of adverse cardiovascular events after stroke in the three groups showed that macrovascular lesions were more likely to occur after stroke(P =0.019).4.According to DSA or MRA or CTA,84 patients with ischemic stroke with macrovascular disease had the following statistical findings: the incidence of cardiovascular adverse events after stroke with single-vessel cerebral vascular disease was 7.14%(1/14);The incidence of adverse cardiovascular events after stroke was21.43%(3/14).The incidence of cardiovascular adverse events after stroke was 71.43%(10/14).The incidence of adverse cardiovascular events after stroke was 50%(7/14)only with anterior circulation vascular lesions;The incidence of adverse cardiovascular events was 21.43%(3/14)only in posterior circulation vascular disease.The incidence of adverse cardiovascular events after stroke was 28.57%(4/14).The incidence of cardiovascular adverse events after ischemic stroke caused by multi-vessel cerebrovascular lesions was statistically different among different vascular lesion groups(P =0.040).5.A total of 92 patients with ischemic stroke with small vessel lesions were found to have 50%(4/8)incidence of cardiovascular adverse events after stroke with white matter lesions.The incidence of cardiovascular adverse events after stroke in the presence of lacunar softening foci was 25%(2/8);The presence of an enlarged peri-cerebrovascular space(VRS)was found to have a 25%(2/8)incidence of adverse cardiovascular events after stroke.Patients in the two groups were divided into the cardiovascular event group and the non-cardiovascular event group according to the occurrence of adverse cardiovascular events.The two groups were statistically compared according to the different manifestations of MRI,and there was no statistical difference between the three manifestations of MRI in ischemic stroke with small vessel lesions(P <0.05).Conclusion:1.The incidence of cardiovascular adverse events IS higher after IS.2.Plasma BNP levels are associated with cardiovascular adverse events after stroke in IS patients.3.Patients with first IS due to macrovascular disease are more likely to have adverse cardiovascular events after stroke.4.Multi-vessel intracranial macrovascular disease IS associated with a higher risk of cardiovascular adverse events within 6 months after stroke in patients with first-time IS. |
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