Background: Determinants of survival and of risk of vascular events after tra nsient ischaemic attack (TIA) or minor ischaemic stroke are not well defined in the long term. We aimed to restudy these risks in a prospec...Background: Determinants of survival and of risk of vascular events after tra nsient ischaemic attack (TIA) or minor ischaemic stroke are not well defined in the long term. We aimed to restudy these risks in a prospective cohort of patien ts after TIA or minor ischaemic stroke (Rankin grade≤ 3), after 10 years or mor e. Methods: We assessed the survival status and occurrence of vascular events in 2473 participants of the Dutch TIA Trial (recruitment in 1986- 89; arterial ca use of cerebral ischaemia). We included 24 hospitals in the Netherlands that rec ruited at least 50 patients. Primary outcomes were all- cause mortality and the composite event of death from all vascular causes, non- fatal stroke, and non - fatal myocardial infarction. We assessed cumulative risks by Kaplan- Meier a nalysis and prognostic factors with Cox univariate and multivariate analysis. Fi ndings: Follow- up was complete in 2447 (99% ) patients. After a mean follow- up of 10.1 years, 1489 (60% ) patients had died and 1336 (54% ) had had at le ast one vascular event. 10- year risk of death was 42.7% (95% CI 40.8- 44. 7). Age and sex- adjusted hazard ratios were 3.33 (2.97- 3.73) for age over 65 years, 2.10 (1.79- 2.48) for diabetes, 1.77 (1.45- 2.15) for claudication, 1. 94 (1.42- 2.65) for previous peripheral vascular surgery, and 1.50 (1.31- 1.71 ) for pathological Q waves on baseline electrocardiogram. 10- year risk of a vascular event was 44.1% (42.0- 46.1). After falling in the first 3 years, yearly risk of a vascular ev ent increased over time. Predictive factors for risk of vascular events were sim ilar to those for risk of death. Interpretation: Long- term secondary preventio n in patients with cerebral ischaemia still has room for further improvement.展开更多
In contrast to earlier observations, recent studies have demonstrated that sup ratentorial lacunar infarcts in the white matter may cause mild neuropsychologic al impairments. The origin of these cognitive disturbance...In contrast to earlier observations, recent studies have demonstrated that sup ratentorial lacunar infarcts in the white matter may cause mild neuropsychologic al impairments. The origin of these cognitive disturbances is yet unknown. In th e current study proton magnetic resonance spectroscopy ( 1HMRS) was used to eluc idate the hypothesized relation between a lacunar infarct, metabolic alterations , and neuropsychological function. Patients with a single supratentorial lacunar infarct(n=26) were compared with patients with a mild myocardial infarct (n=12) and healthy controls (n=12) on a comprehensive neuropsychological examination, and on the N-acetyl-aspartate/creatine, choline/creatine and lactate/creatine ratios. The volume of interest of the MRI/MRS examination was locatedin normal- appearing white matter of the centrum semiovale ata distance from the infarct, i n both the ipsilateral and contralateral hemisphere. On neuropsychological exami nation patients with a lacunar infarct performed worse than both patients with a myocardial infarct and healthy controls. The N-acetyl-aspartate/creatine rati o was decreased in patients with a lacunar infarct compared with the other two g roups. More important,this decrease in neurometabolites was significantly correl ated to the level of cognitive functioning for the ipsilateral hemisphere and, a lthough to a lesser extent, for the contralateral hemisphere.We conclude that a single symptomatic lacunar infarct in the white matter is associated with (distant) disturbances in neuro metabolites and that this decrease is related to a reduced cognitive capacity.展开更多
文摘Background: Determinants of survival and of risk of vascular events after tra nsient ischaemic attack (TIA) or minor ischaemic stroke are not well defined in the long term. We aimed to restudy these risks in a prospective cohort of patien ts after TIA or minor ischaemic stroke (Rankin grade≤ 3), after 10 years or mor e. Methods: We assessed the survival status and occurrence of vascular events in 2473 participants of the Dutch TIA Trial (recruitment in 1986- 89; arterial ca use of cerebral ischaemia). We included 24 hospitals in the Netherlands that rec ruited at least 50 patients. Primary outcomes were all- cause mortality and the composite event of death from all vascular causes, non- fatal stroke, and non - fatal myocardial infarction. We assessed cumulative risks by Kaplan- Meier a nalysis and prognostic factors with Cox univariate and multivariate analysis. Fi ndings: Follow- up was complete in 2447 (99% ) patients. After a mean follow- up of 10.1 years, 1489 (60% ) patients had died and 1336 (54% ) had had at le ast one vascular event. 10- year risk of death was 42.7% (95% CI 40.8- 44. 7). Age and sex- adjusted hazard ratios were 3.33 (2.97- 3.73) for age over 65 years, 2.10 (1.79- 2.48) for diabetes, 1.77 (1.45- 2.15) for claudication, 1. 94 (1.42- 2.65) for previous peripheral vascular surgery, and 1.50 (1.31- 1.71 ) for pathological Q waves on baseline electrocardiogram. 10- year risk of a vascular event was 44.1% (42.0- 46.1). After falling in the first 3 years, yearly risk of a vascular ev ent increased over time. Predictive factors for risk of vascular events were sim ilar to those for risk of death. Interpretation: Long- term secondary preventio n in patients with cerebral ischaemia still has room for further improvement.
文摘In contrast to earlier observations, recent studies have demonstrated that sup ratentorial lacunar infarcts in the white matter may cause mild neuropsychologic al impairments. The origin of these cognitive disturbances is yet unknown. In th e current study proton magnetic resonance spectroscopy ( 1HMRS) was used to eluc idate the hypothesized relation between a lacunar infarct, metabolic alterations , and neuropsychological function. Patients with a single supratentorial lacunar infarct(n=26) were compared with patients with a mild myocardial infarct (n=12) and healthy controls (n=12) on a comprehensive neuropsychological examination, and on the N-acetyl-aspartate/creatine, choline/creatine and lactate/creatine ratios. The volume of interest of the MRI/MRS examination was locatedin normal- appearing white matter of the centrum semiovale ata distance from the infarct, i n both the ipsilateral and contralateral hemisphere. On neuropsychological exami nation patients with a lacunar infarct performed worse than both patients with a myocardial infarct and healthy controls. The N-acetyl-aspartate/creatine rati o was decreased in patients with a lacunar infarct compared with the other two g roups. More important,this decrease in neurometabolites was significantly correl ated to the level of cognitive functioning for the ipsilateral hemisphere and, a lthough to a lesser extent, for the contralateral hemisphere.We conclude that a single symptomatic lacunar infarct in the white matter is associated with (distant) disturbances in neuro metabolites and that this decrease is related to a reduced cognitive capacity.
