Keywords
Skor CHD2DS2C-VASc
Aterosklerosis
Stroke Iskemik
How to Cite
Abstract
ABSTRACT
Atherosclerosis results from the accumulation of lipid complexes in the tunica intima of blood vessels and is associated with several risk factors for stroke. The CHADS2 and CHA2DS2-VASc scores were associated with stroke risk factors such as hypertension, DM, stroke-history/TIA, and advanced age. This study aims to determine the relationship between CHADS2 and CHA2DS2-VASc scores with atherosclerosis in ischemic stroke patients. This research is observational with cross sectional approach. The study sample was ischemic stroke patients who were treated in the nervous room of Dr. Zainoel Abidin Hospital Banda Aceh June-September 2022. Atherosclerosis was assessed using a Transcranial Doppler (TCD) device by measuring the pulsatile index of the left and right middle cerebral arteries (ASM). The study sample was 60 ischemic stroke patients, consisting of 35 men (58.3%) and 25 women (41.7%). Stroke infarct patients with atherosclerosis showed a relatively similar mean pulsatile index of the left (1.15 + 0.17) and right (1.15 + 0.18) middle cerebral arteries. The increase in CHADS2C and CHD2DS2C-VASc scores was followed by an increase in the pulsatile index of the left and right middle cerebral arteries. Stroke infarct patients who have atherosclerosis are 76.7%. CHADS2C and CHD2DS2C-VASc scores showed a significant relationship with atherosclerosis in ischemic stroke patients (CI95%, p=0.000).
Keyword: CHADS2C score, CHD2DS2C-VASc score, atherosclerosis and ischemic stroke.
ABSTRAK
Atherosclerosis terjadi akibat penimbunan kompleks lipid di dalam tunika intima pembuluh darah dan berhubungan dengan beberapa faktor risiko stroke. Skor CHADS2 dan CHA2DS2-VASc terkait dengan faktor risiko stroke seperti hipertensi, DM, riwayat-stroke/TIA, dan usia lanjut. Penelitian ini bertujuan untuk mengetahui hubungan skor CHADS2 dan CHA2DS2-VASc dengan atherosclerosis pada pasien stroke iskemik. Penelitian ini bersifat observasional dengan pendekatan cross sectional. Sampel penelitian adalah pasien stroke iskemik yang dirawat di ruang saraf Rumah Sakit dr Zainoel Abidin Banda Aceh Juni-September 2022. Atherosklerosis dinilai menggunakan alat Trancranial Doppler (TCD) dengan mengukur pulsatile index arteri serebri media (ASM) kiri dan kanan. Sampel penelitian adalah 60 pasien stroke iskemik, terdiri atas 35 pria (58.3%) dan 25 wanita (41.7%). Pasien-pasien stroke infark yang mengalami atherosklerosis menunjukkan pulsatile index rata-rata arteri serebri media kiri (1.15 + 0.17) dan kanan (1.15 + 0.18) yang relatif sama. Peningkatan Skor CHADS2C dan CHD2DS2C-VASc diikuti peningkatan pulsatile index arteri serebri media kiri dan kanan. Pasien stroke infark yang mengalami atherosclerosis adalah sebesar 76.7%. Skor CHADS2C dan CHD2DS2C-VASc menunjukkan hubungan bermakna dengan atherosklerosis pada pasien stroke iskemik (IK 95%,p=0.000).
Kata kunci: Skor CHADS2C, skor CHD2DS2C-VASc, aterosklerosis dan stroke iskemik.
References
Banerjee, C. and Chimowitz, M. I. (2017) ‘Stroke Caused by Atherosclerosis of the Major Intracranial Arteries’, Circulation Research, 120(3), pp. 502–513. doi: 10.1161/CIRCRESAHA.116.308441.
Bentzon, J. F. et al. (2014) ‘Mechanisms of plaque formation and rupture’, Circulation Research, 114(12), pp. 1852–1866. doi: 10.1161/CIRCRESAHA.114.302721.
Bill, O. et al. (2020) ‘Predictors of the pulsatility index in the middle cerebral artery of acute stroke patients’, Scientific Reports. Nature Publishing Group UK, 10(1), pp. 1–8. doi: 10.1038/s41598-020-74056-2.
Bushnell, C. D. et al. (2018) ‘Sex differences in stroke: Challenges and opportunities’, Journal of Cerebral Blood Flow and Metabolism, 38(12), pp. 2179–2191. doi: 10.1177/0271678X18793324.
Chao, T. F. et al. (2016) ‘Validation of a Modified CHA2DS2-VASc Score for Stroke Risk Stratification in Asian Patients with Atrial Fibrillation’, Stroke, 47(10), pp. 2462–2469. doi: 10.1161/STROKEAHA.116.013880.
Dahl-Jørgensen, K., Larsen, J. R. and Hanssen, K. F. (2005) ‘Atherosclerosis in childhood and adolescent type 1 diabetes: Early disease, early treatment?’, Diabetologia, 48(8), pp. 1445–1453. doi: 10.1007/s00125-005-1832-1.
Gimbrone, M. A. and García-Cardeña, G. (2016) ‘Endothelial Cell Dysfunction and the Pathobiology of Atherosclerosis’, Circulation Research, 118(4), pp. 620–636. doi: 10.1161/CIRCRESAHA.115.306301.
Heyer, E. J., Mergeche, J. L. and Connolly, E. S. (2014) ‘Middle cerebral artery pulsatility index and cognitive improvement after carotid endarterectomy for symptomatic stenosis: Clinical article’, Journal of Neurosurgery, 120(1), pp. 126–131. doi: 10.3171/2013.8.JNS13931.
Kim, Y. D. et al. (2011) ‘Increases in cerebral atherosclerosis according to CHADS2 scores in patients with stroke with nonvalvular atrial fibrillation’, Stroke, 42(4), pp. 930–934. doi: 10.1161/STROKEAHA.110.602987.
Klop, B., Elte, J. W. F. and Cabezas, M. C. (2013) ‘Dyslipidemia in Obesity: Mechanisms and Potential Targets’, Nutrients, 5(4), pp. 1218–1240. doi: 10.3390/nu5041218.
Li, Y. et al. (2008) ‘Effect of aging on fatty streak formation in a diet-induced mouse model of atherosclerosis’, Journal of Vascular Research, 45(3), pp. 205–210. doi: 10.1159/000112133.
Markus, H. S. (2004) ‘Cerebral perfusion and stroke’, Journal of Neurology, Neurosurgery and Psychiatry, 75(3), pp. 353–361. doi: 10.1136/jnnp.2003.025825.
McGill, J. et al. (2000) ‘Origin of atherosclerosis in childhood and adolescence’, American Journal of Clinical Nutrition, 72(5 SUPPL.). doi: 10.1093/ajcn/72.5.1307s.
Melgaard, L. et al. (2015) ‘Assessment of the CHA2DS2-VASc score in predicting ischemic stroke, thromboembolism, and death in patients with heart failure with and without atrial fibrillation’, JAMA - Journal of the American Medical Association, 314(10), pp. E1–E9. doi: 10.1001/jama.2015.10725.
Milutinović, A., Šuput, D. and Zorc-Pleskovič, R. (2020) ‘Pathogenesis of atherosclerosis in the tunica intima, media, and adventitia of coronary arteries: An updated review’, Bosnian Journal of Basic Medical Sciences, 20(1), pp. 21–30. doi: 10.17305/bjbms.2019.4320.
Mitchell, L. B. et al. (2014) ‘Prediction of stroke or TIA in patients without atrial fibrillation using CHADS2 and CHA2DS2-VASc scores’, Heart, 100(19), pp. 1524–1530. doi: 10.1136/heartjnl-2013-305303.
Morrone, D. et al. (2020) ‘Mortality prediction of the cha2 ds2-vasc score, the has-bled score, and their combination in anticoagulated patients with atrial fibrillation’, Journal of Clinical Medicine, 9(12), pp. 1–17. doi: 10.3390/jcm9123987.
Peng, J. et al. (2017) ‘Hypertriglyceridemia and atherosclerosis’, Lipids in Health and Disease. Lipids in Health and Disease, 16(1). doi: 10.1186/s12944-017-0625-0.
Rafieian-Kopaei, M. et al. (2014) ‘Atherosclerosis: Process, indicators, risk factors and new hopes’, International Journal of Preventive Medicine, 5(8), pp. 927–946.
Reeves, M. J. et al. (2008) ‘Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes’, The Lancet Neurology, 7(10), pp. 915–926. doi: 10.1016/S1474-4422(08)70193-5.
Sacco, R. L. et al. (2013a) ‘An updated definition of stroke for the 21st century: A statement for healthcare professionals from the American heart association/American stroke association’, Stroke, 44(7), pp. 2064–2089. doi: 10.1161/STR.0b013e318296aeca.
Sacco, R. L. et al. (2013b) ‘An updated definition of stroke for the 21st century: A statement for healthcare professionals from the American heart association/American stroke association’, Stroke, 44(7), pp. 2064–2089. doi: 10.1161/STR.0b013e318296aeca.
Sekerdag, E., Solaroglu, I. and Gursoy-Ozdemir, Y. (2018) ‘Cell Death Mechanisms in Stroke and Novel Molecular and Cellular Treatment Options’, Current Neuropharmacology, 16(9), pp. 1396–1415. doi: 10.2174/1570159x16666180302115544.
Shaw, G. (2019) ‘The National Academy of Medicine Calls for Action on Physician Burnout’, Neurology Today, 19(23), pp. 27–30. doi: 10.1097/01.nt.0000617168.64963.af.
Tousoulis, Di. et al. (2016) ‘Inflammatory cytokines in atherosclerosis: Current therapeutic approaches’, European Heart Journal, 37(22), pp. 1723–1735. doi: 10.1093/eurheartj/ehv759.
Tuo, Q. zhang, Zhang, S. ting and Lei, P. (2022) ‘Mechanisms of neuronal cell death in ischemic stroke and their therapeutic implications’, Medicinal Research Reviews, 42(1), pp. 259–305. doi: 10.1002/med.21817.
Vigen, T. et al. (2020) ‘Carotid Atherosclerosis is Associated with Middle Cerebral Artery Pulsatility Index’, Journal of Neuroimaging, 30(2), pp. 233–239. doi: 10.1111/jon.12684.
Webb, A. J. S. et al. (2012) ‘Increased cerebral arterial pulsatility in patients with leukoaraiosis: Arterial stiffness enhances transmission of aortic pulsatility’, Stroke, 43(10), pp. 2631–2636. doi: 10.1161/STROKEAHA.112.655837.
Wu, Y. et al. (2021) ‘Assessment of the CHA2DS2-VASc Score for the Prediction of Death in Elderly Patients With Coronary Artery Disease and Atrial Fibrillation’, Frontiers in Cardiovascular Medicine, 8(December), pp. 1–9. doi: 10.3389/fcvm.2021.805234.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2024 Imran Isa, Farida, Devi Yanti