Cardiac diagnostic work-up of ischaemic stroke

Yang, Hayang; Nassif, Martina; Khairy, Paul; Groot, Joris R. de; Roos, Yvo B.W.E.M.; Winter, Robbert J. de; Mulder, Barbara J.M.; Bouma, Berto J.

doi:10.1093/eurheartj/ehy043

Cited by 29 publications

(20 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Another marked difference in our population compared to other studies is the high prevalence of cardioembolic strokes in the older group, which accounted for 43.3% of all ischaemic strokes, and low prevalence of cryptogenic stroke (18.1%). Recent data estimate that cardioembolic strokes account for 20–30% and cryptogenic mechanisms are responsible for 30–40% of ischaemic strokes across all ages . However, using extended cardiac monitoring, up to 9.2% of cryptogenic strokes can be re‐classified as due to atrial fibrillation, a major cause of cardioembolism .…”

Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors of ischaemic stroke in the young: a regional Australian perspective

Siriratnam

Godfrey

O'Connor

et al. 2020

Internal Medicine Journal

View full text Add to dashboard Cite

Background There is no universally accepted age cut‐off for defining young strokes. Aims We aimed to determine, based on the profile of young stroke patients in our regional centre, an appropriate age cut‐off for young strokes. Methods A retrospective analysis of all ischaemic stroke patients admitted to our centre from 2015 to 2017. We identified 391 ischaemic stroke patients; 30 patients between the ages of ≤50, 40 between 51–60 inclusive and 321 ≥ 61 years of age. We collected data on demographic profiles, risk factors and stroke classification using the Trial of Org 10 172 in Acute Stroke Treatment criteria. Results We found significant differences between the ≤50 and ≥61 age groups for most of the risk factors and similarities between the 51–60 inclusive and ≥ 61 age groups. At least one of the six risk factors assessed in the study was present in 86.7% of the youngest group, 97.5% of the intermediate age group and 97.2% in the oldest group. In terms of the mechanisms of stroke, the youngest and oldest age groups in our study differed in the prevalence of cryptogenic, cardioembolic and other causes of stroke. The middle and older age groups had similar mechanisms of stroke. Conclusions The prevalence of vascular risk factors and mechanisms of stroke likewise differed significantly across age groups. This study suggests that 50 years is an appropriate age cut‐off for defining young strokes and reinforces the importance of primary prevention in all age groups.

show abstract

Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors of ischaemic stroke in the young: a regional Australian perspective

Siriratnam

Godfrey

O'Connor

et al. 2020

Internal Medicine Journal

View full text Add to dashboard Cite

show abstract

“…Despite extensive etiologic investigations, no specific cause has been found in 30–40% of ischemic stroke patients [5]. In the literature, it has been reported that the etiology of these patients with strokes of undetermined origin, or otherwise referred to as "cryptogenic strokes," is likely to be thromboembolic, and the emboli are mostly of cardiac origin [12,13].…”

Section: Discussionmentioning

confidence: 99%

“…Cardioembolic stroke has a worse prognosis than other etiological factors in terms of mortality, disability, and recurrence [17]. Although many cardioembolic risk factors that result in ischemic stroke are known, the most common cardioembolic stroke cause in daily clinical practice is atrial fibrillation [5,17]. Paroxysmal or chronic atrial fibrillation is known as a well-defined etiologic cause of ischemic stroke, and the risk of stroke can be reduced by appropriate anticoagulant therapy with both primary and secondary prevention [18].…”

Section: Discussionmentioning

confidence: 99%

“…The most common etiologic causes of ischemic stroke are classified as atherosclerosis of major arteries, cardioembolism, small vessel occlusions, other determined causes, and undetermined causes [4]. Cardioembolic stroke accounts for 20–30% of the cases, whereas no etiologic cause is found in 30–40% of the patients despite having performed all the necessary diagnostic tests [5,6]. The etiology of cryptogenic strokes is frequently reported as cardiac thromboembolism.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Relationship between Diffusion-Weighted Magnetic Resonance Imaging Lesions and 24-Hour Rhythm Holter Findings in Patients with Cryptogenic Stroke

et al. 2019

View full text Add to dashboard Cite

Background and objectives: Cranial magnetic resonance imaging findings of patients considered to be cryptogenic stroke may be useful in determining the clinical and prognostic significance of arrhythmias, such as atrial premature beats and atrial run attacks, that are frequently encountered in rhythm Holter analysis. This study was conducted to investigate the relationship between short atrial runs and frequent premature atrial contractions detected in Holter monitors and infarct distributions in cranial magnetic resonance imaging of patients diagnosed with cryptogenic stroke. Materials and Methods: We enrolled the patients with acute ischemic stroke whose etiology were undetermined. We divided the patients in two groups according to diffusion-weighted magnetic resonance imaging as single or multiple vascular territory acute infarcts. The demographic, clinical, laboratory, echocardiographic, and rhythm Holter analyses were compared. Results: The study investigated 106 patients diagnosed with cryptogenic stroke. Acute cerebral infarctions were detected in 31% of the investigated patients in multiple territories and in 69% in a single territory. In multivariate logistic regression analysis, the total premature atrial contraction count (OR = 1.002, 95% CI: 1.001–1.004, p = 0.001) and short atrial run count (OR = 1.086, 95% CI: 1.021–1.155, p = 0.008) were found as independent variables that could distinguish between infarctions in a single or in multiple vascular territories. Conclusions: Rhythm Holter monitoring of patients with infarcts detected in multiple vascular territories showed significantly higher premature atrial contractions and short atrial run attacks. More effort should be devoted to the identification of cardioembolic etiology in cryptogenic stroke patients with concurrent acute infarcts in the multiple vascular territories of the brain.

show abstract

“…27 Medium/low-risk sources included mitral annular calcification, aortic valve calcification, patent foramen ovale, 11 atrial septal aneurysm, and presence of LV aneurysm without thrombus. 28 In addition, filling defects suspected to be an intracardiac thrombus, but lacking an oval shape or lower attenuation, were noted as a medium/low-risk source. 26,27 Outcome assessments…”

Section: Image Analysismentioning

confidence: 99%

CT Angiography of the Heart and Aorta in TIA and Ischaemic Stroke: Cardioembolic Risk Sources and Clinical Implications

Holswilder

Wermer

Holman

et al. 2020

Journal of Stroke and Cerebrovascular Diseases

View full text Add to dashboard Cite

Background: Cardiac emboli are important causes of (recurrent) ischaemic stroke. Aorta atherosclerosis might also be associated with an increased risk of stroke recurrence. This study aimed to evaluate the yield and clinical implications of CTangiography (CTA) of the heart and aorta in the diagnostic workup of transient ischaemic attack (TIA) or ischaemic stroke. Methods: CTA of the heart and aortic arch was performed in TIA/ischaemic stroke patients, in addition to routine diagnostic workup. Occurrence of cardioembolic (CE) risk sources and complex aortic plaques were assessed. Implications of cardiac CTA for therapeutic management were evaluated Results: Sixty-seven patients were included (TIA n = 33, ischaemic stroke n = 34) with a mean age of 68 years (range 51À89) and median NIHSS of 0 (interquartile range 0À2). CE risk sources were detected in 29 (43%) patients. An intracardiac thrombus was present in 2 patients (3%; TIA 0%; ischaemic stroke 6%). Medium/low-risk CE sources included mitral annular calcification (9%), aortic valve calcification (18%) and patent foramen ovale (18%). Complex aortic plaque was identified in 16 patients (24%). In two patients with an intracardiac thrombus, therapeutic management changed from antiplatelet to oral anticoagulation. Conclusions: CTA of the heart and aorta has a high yield for detection of embolic risk sources in TIA/ ischaemic stroke, with clinical consequences for 6% of ischaemic stroke patients. Implementation of CTA of the heart and aorta in the acute stroke setting seems valuable, but cost-effectiveness of this approach remains to be determined.

show abstract

Cardiac diagnostic work-up of ischaemic stroke

Cited by 29 publications

References 54 publications

Prevalence and risk factors of ischaemic stroke in the young: a regional Australian perspective

Prevalence and risk factors of ischaemic stroke in the young: a regional Australian perspective

The Relationship between Diffusion-Weighted Magnetic Resonance Imaging Lesions and 24-Hour Rhythm Holter Findings in Patients with Cryptogenic Stroke

CT Angiography of the Heart and Aorta in TIA and Ischaemic Stroke: Cardioembolic Risk Sources and Clinical Implications

Contact Info

Product

Resources

About