Clinical and echocardiographic characteristics of cardioembolic stroke

Abstract

Background and purpose Ischaemic stroke frequently has a cardioembolic (CE) source. Clinical and echocardiographic parameters associated with CE stroke were evaluated. Methods In all, 93 consecutive ischaemic stroke patients who underwent a transthoracic echocardiogram were retrospectively analysed; strokes were classified by TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria. Echocardiographic parameters related to CE stroke, including left atrial volumes and function, were compared to 73 healthy controls. Results Of 93 patients (mean age 66.1 years, 56% male), nine (10%) had large artery atherosclerosis, 38 (41%) CE stroke, two (2%) small vessel disease, two (2%) other and 42 (45%) undetermined aetiology. Left atrial (LA) maximum volumes (LAVImax) and minimum volumes (LAVImin) were larger in the CE group than the non‐CE group (45 vs. 32 ml/m2, 32 vs. 13 ml/m2, respectively, P < 0.001), whilst LA function indices including LA emptying fraction and LA function index (LAFI) were lower in the CE group (34% vs. 55%, and 0.12 vs. 0.35, respectively, P < 0.001). Adjusting for clinical characteristics, LAFI ≤0.3 was an independent predictor of CE stroke (adjusted odds ratio 5.3, P = 0.001). Additionally, LAVImax and LAVImin were larger (61 vs. 44 and 32 vs. 24 ml/m2 respectively, P < 0.01) and LAFI significantly lower (0.34 vs. 0.52, P < 0.001) in the undetermined aetiology group versus healthy controls. Conclusions Left atrial enlargement with reduced LA function was associated with CE stroke and LAFI was the best independent predictor. LA parameters were also altered in the undetermined aetiology group, suggesting an underlying LA myopathy in this subset.

Using Clinical and Echocardiographic Characteristics to Characterize the Risk of Ischemic Stroke in Patients with COVID-19

“…Left atrial dilation and the presence of LV thrombus are recognized risk factors for ischemic stroke that were observed to occur with greater frequency in patients who had ischemic stroke in our population. [23][24][25] The burden of ischemic stroke in patients less than 55 years of age in our population is congruent with the observation that incidence of ischemic stroke, particularly large vessel occlusive stroke, has occurred with higher incidence in younger patients with COVID-19 compared to controls. 26 An elevated admission systolic blood pressure, defined in this study as >140 mmHg, was significantly higher in patients with ischemic stroke despite diagnosis of ischemic stroke occurring a median 7 days (1-17) from admission and was also included.…”

“… 2 , 3 , 4 In retrospective studies, ischemic stroke has been identified in 0.5-5.8% of patients hospitalized with COVID-19. 5 , 6 , 7 , 8 , 9 , 10 Infection with COVID-19 has been independently associated with acute ischemic stroke compared with control subjects and the severity of COVID-19 syndrome correlates with risk acute stroke. 9 , 11 The likelihood of ischemic stroke is markedly higher in patients hospitalized with COVID-19 infection compared with controls hospitalized with influenza infection.…”

Demographic and clinical profile of cardioembolic stroke patients in Western Sydney

“…Specialised tests such as vasculitis and thrombophilia screens were performed in a small group of patients where it was determined by the treating physician to be clinically indicated. We have previously examined echocardiographic data that were available in a subgroup of 93 stroke patients . CHADS 2 and CHA 2 DS 2 ‐VASC scores on presentation were calculated in the subgroup with AF.…”

Biomarkers of atrial cardiopathy in patients with different pathogenetic subtypes of ischemic stroke

“…Полученные различия функциональных маркеров ЛП при сравнении группы КЭИ с другими подтипами инсульта соответствуют результатам исследования A. Ferkh и соавт. (2019) [28] Выполненное нами исследование также выявило различия в сывороточной концентрации NT-proBNP между пациентами с КЭИ и КИ/неКЭИ. Пороговая величина пептида, позволяющая дифференцировать КЭИ и неКЭИ, составила 316 пг/мл, что несколько ниже значения, полученного J. Zhao и соавт.…”

“…Таким образом, нормальные значения LAEF отражают функциональную состоятельность миокарда предсердий, при которой возможна адаптивная компенсация за счет уменьшения доли пассивной составляющей, а процессы ремоделирования, связанные с ФП, несмотря на дилатацию ЛП, обратимы [31]. В то же время другие авторы [28,32] рассматривают LAEF в качестве показателя, отражающего именно резервуарную функцию ЛП. На наш взгляд, LAEF характеризует единый процесс, ассоциированный не только с механизмом передачи крови из ЛП в ЛЖ, но и с изначальным объемом депонированной крови.…”