Biomarkeri atrijalne kardiopatije i moždani udar nepoznatog porekla
Atrijalna kardiopatija i ESUS
Sažetak
Istraživanja ukazuju da patološki atrijalni supstrat može izazvati embolijski moždani udar čak i kod pacijenata bez atrijalne fibrilacije. Ovo stanje se naziva "atrijalna kardiopatija" i ukazuje na promene srčanih pretkomora koji mogu da prethode AF. Subklinička AF može se detektovati kod 30% pacijenata koji imaju moždani udar neutvrđanog uzroka( Embolic Stroke of Undetermined Source- ESUS). Cilj ovog narativnog pregleda je da na osnovu aktuelnog pregleda literature pruži podatke o patogenezi i markerima atrijalne kardiopatije, povezanosti atrijalne kardiopatije i ESUS-a i terapijskim mogućnostima u slučaju detekcije iste u cilju prevencije embolijskog događaja. Atrijalna kardiopatija kao patološki supstrat pre razvoja manifestne AF može biti potencijalni mehanizam nastanka ESUS-a. Evaluacija biomarkera atrijalne kardiopatije (terminalna sila P-talasa u elektrodi V1 (>5.000 µVms), N-terminalni pro- natriuretski peptid >250 pg/ml i povećanje leve pretkomore) može biti polazna tačka identifikaciju rizika od ESUS-a kao i za pravovremenu terapijsku intervenciju moždanog udara primenom direktne oralne antikoagulantne terapije kod ESUS pacijente sa atrijalnom kardiomiopatijom. Zaključno, biomarkeri atrijalne kardiopatije su korisni za praćenje kompletna etiološka procena radi klasifikacije pacijenata u ESUS grupu, kao i dinamično dugoročno praćenje pacijenata u cilju detekcije okultne AF su otežavajući faktori za razumevanje povezanosti atrijalne kardiopatije i ESUS-a. Dalja istraživanja na području atrijalne kardiomiopatije kao faktora rizika za ESUS su od izuzetnog značaja radi pravovremenog uvođenja DOAK
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