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RÉSUMÉ
Introduction. Selon la classification de Toast, les cardiopathies emboligènes représentent environ 25 à 30 des causes d’AVC ischémique. L’objectif de notre étude était de déterminer la fréquence et le pronostic des infarctus cérébraux d’origine cardiaque en milieu neurologique ivoirien. Méthodologie. Nous avons mis en place une étude rétrospective à visée descriptive et analytique. Résultats. Sur 121 cas d’AVC ischémique recensés durant une année, 79 dossiers ont pu être exploités. La moyenne d’âge des patients était de 66 ans avec une prédominance masculine. L’HTA constituait le principal facteur de risque (75,9%). Selon la classification de Toast, on notait 25,3% de causes cardiaques dont 15% de fibrillation auriculaire. La durée d’hospitalisation (8,5 vs 5,6 jours p=0,05), les complications de décubitus (40,0 vs 11,8 p=0,01) et le score de Rankin modifié à 90 jours > 2 (58,0 vs 47,9 p=0,74)) étaient plus importants dans les cas de cardiopathies emboligènes que dans les autres causes. Conclusion. Cette étude confirme la fréquence élevée et le pronostic sévère des causes cardiaques d’infarctus cérébral.
ABSTRACT
Introduction. According to Toast classification, heart disease represents approximately 25 to 30 causes of ischemic stroke. Our objective was to determine frequency and prognosis of cardioembolism stroke in an ivorian neurological environment. Methodology. This was a retrospective study with descriptive and analytical aims. Results. Out of 121 cases of ischemic stroke recorded during one year, 79 files could be used. The mean age was 66 years with a male predominance. Hypertension was the main risk factor (75.9%). According to the Toast classification, there were 25.3% of cardiac causes including 15% atrial fibrillation. Length of hospitalization (8.5 vs 5.6 days p=0.05), decubitus complications (40.0 vs 11.8 p=0.01) and modified Rankin score at 90 days > 2 (58.0 vs 47.9 p=0.74) were more significant in cases of cardioembolic stroke. Conclusion. This study confirms the high frequency and severe prognosis of cardiac causes of ischemic strokes.
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References
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- -Camara S, Ahmed A, Ba H, Gata BF, Boye KI, Ouali S et al.
- Accidents vasculaires cérébraux ischémiques d’origine cardio-embolique : à propos de 101 cas colligés au Centre National de Cardiologie de Nouakchott (Mauritanie). Revue Tunisienne de Cardiologie. 2019;15(2) :61-8
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References
-Akinyemi R. A, Ovbiagele B, Adenji O, Sarfo F, Abd-Allah F, Adoukonou T and al. Stroke in Africa: profile, progress, prospects and priorities. Nrneur. 2021;17:634-56. https://doi.org/10.1038/ s41582-021-00542-4
-Krishnamurthi RV, Feigin VL, Forouzanfar MH, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet Glob Health. 2013:259-81.
-Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL and al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke.1993;24: 35-41.
-Bogiatzi C, Hackam DG, McLeod AI, Spence JD. Secular trends in ischemic stroke subtypes and stroke risk factors. Stroke. 2014;45:3208–13.
-Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M and al.Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014;129:837-47.
-Allognon MC, Ayo BE, Nyangui MJ, Agbo AFK, Camara AI, Ngnigone P and al. Sources cardio-emboliques d’accidents vasculaires cérébraux ischémiques au Centre Hospitalier Universitaire de Libreville. Bull Med Owendo.2020;18(49):28-33.
- Mapoure YN, Kamdem F, Akeyeh FJ, Dzudie A, Mouliom S, Mouelle AS and al. Cardio-embolic stroke: Lessons from a single centre in Sub-Saharan Africa. Revue neurol. 2019;175:544-51.
- Mboup MC, Sarr SA, Dia K, Fall PD. Aspects étiologiques des accidents vasculaires cérébraux ischémiques au Sénégal. Pan Afr Med J.2015;22:201
-Kimura K, Yamashita S, Shibazaki K. Cardioembolic stroke associated with atrial fibrillation. Rinsho Shinkeigaku 2013;53(11):989–91
-Vinsonneau U, Leblanc A, Buchet JF, Pangnarind-Heintz V, Legal G, Rohel G and al. Rentabilité diagnostique de l’échographie cardiaque transthoracique, transoesophagienne et du Holter ECG réalisés à titre systématique lors du bilan étiologique d’un premier accident vasculaire cérébral ischémique. Etude rétrospective de 220 patients. Ann Cardiol Angeiol.2014;63:217-21.
-Grau AJ, Weimar C, Buggle F, Heinrich A, Goertler M, Neumaier S and al. Risk factors, outcome, and treatment in subtypes of ischemic stroke: the German stroke data bank. Stroke. 2001;32(11):2559-66.
-Jurjāns K, Cērpa M, Baborikina A, Kalējs O, Miglāne E. Impact of Anticoagulants in Reducing Mortality and Disability in Cardioembolic Stroke Patients. Medicina.2022; 58(10):1323. https://doi.org/10.3390/medicina58101323
-Guglielmi V, Le Couffe NE, Zinkstok SM, Compagne KC, Eker R, Treurniet KM et al. Collateral Circulation and Outcome in Atherosclerotic Versus Cardioembolic Cerebral Large Vessel Occlusion. Stroke.2019;50:3360-8.
-Heshmatollah A, Fransen PSS, Berkhemer OA, Beumer D, van der Lugt A, Majoie C, et al. Endovascular thrombectomy in patients with acute ischaemic stroke and atrial fibrillation: A Mr clean subgroup analysis. EuroIntervention. 2017;13:996-1002.
-Lubitz SA, Yin X, McManus DD, et al. Stroke as the initial manifestation of atrial fibrillation: the Framingham Heart Study. Stroke.2017;48(2):490-2
-Sposato LA, Cipriano LE, Saposnik G, Ruíz VE, Riccio PM, Hachinski V. Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol. 2015;14(4):377-87.
-Konaté M, Sonfo B, Sako M, Sidibé S, Mariko S, Sow DS et al. Explorations cardiovasculaires chez les patients hospitalisés pour un accident vasculaire cérébral ischémique dans le service de médecine à l’hôpital du Mali (Bamako). Explorations cardio-vasculaires dans l’AVCI à Bamako. Health Sci. Dis. 2021;22(4):71-5.
-Nakanishi K, Homma S. Role of echocardiography in patients with stroke. Journal of Cardiology.2016;68:91-9.
-Camara S, Ahmed A, Ba H, Gata BF, Boye KI, Ouali S et al.
Accidents vasculaires cérébraux ischémiques d’origine cardio-embolique : à propos de 101 cas colligés au Centre National de Cardiologie de Nouakchott (Mauritanie). Revue Tunisienne de Cardiologie. 2019;15(2) :61-8
-Canali E, Serani M, Tarzia P, Ciampi P, Canestrelli S, Calo L. Echocardiography in cardioembolic stroke prevention. Eur Heart J Suppl. 2023;25(C):212-7.
-Seiffge DJ, Werring DJ, Paciaroni M, Dawson J, Warach S, Milling TJ and al.Timing of anticoagulation after recent ischaemic stroke in patients with atrial fibrillation. Lancet Neurol.2019;18:117-26.