P6389Arterial stiffness and indices of diastolic heart failure as predictors of ischemic strokes of undetermined etiology

Bielecka‐Dąbrowa, Agata; Gąsiorek, Paulina; Sakowicz, Agata; Banach, Maciej

doi:10.1093/eurheartj/ehy566.p6389

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“…In our study, ESUS patients had lower mean early diastolic ( E ′) and systolic ( S ′) mitral annular velocities and a higher E / E ′ ratio as well as longer IVRT compared to the control group, which confirms the connection between indices of diastolic heart failure and ESUS stroke. Even slightly increased values of LAVI (cutoff point 24 mL/m 2 ) and NT-proBNP (cutoff point 99 pg/mL) were predictors of this type of stroke [11]. Further investigation is necessary to attribute the additive values of echocardiographic parameters for stroke prediction and the effect of left ventricular end-diastolic pressure (LVEDP) control on the reduction of ischemic stroke events.…”

Section: Discussionmentioning

confidence: 99%

“…We enrolled patients (males, females; age median 54 (interquartile range, IQR 47-58) years) with ESUS and 36 to the control group (median 53 age 47-58 years, 61% male) from the Department of Hypertension, Medical University of Lodz. All patients underwent neuroimaging examination, arterial ultrasound examination, electrocardiogram (ECG) monitoring, echocardiography, and noninvasive assessment of hemodynamic parameters using a SphygmoCor tonometer [9, 11]. Other measurements obtained included the levels of selected biochemical biomarkers.…”

Section: Methodsmentioning

confidence: 99%

“…The results of this study were presented during the European Society of Cardiology Congress in Munich in 2018 [11].…”

Section: Disclosurementioning

confidence: 99%

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Arterial Stiffness and Indices of Left Ventricular Diastolic Dysfunction in Patients with Embolic Stroke of Undetermined Etiology

et al. 2019

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Purpose. The study is aimed at identifying echocardiographic and circulating biomarkers as well as hemodynamic indices of embolic stroke of undetermined etiology (ESUS) in patients aged <65. Methods. We prospectively investigated 520 patients with confirmed ischemic stroke and selected those 65 patients who were diagnosed with ESUS (age 54 (47-58) years, 42% male). An additional 36 without stroke but with a similar risk profile were included as a control group (age 53 (47-58) years, 61% male). All patients underwent echocardiography, noninvasive assessment of hemodynamic parameters using a SphygmoCor tonometer (AtCor Med., Australia), and measurements of selected biomarkers. Results. ESUS patients and controls were well matched for baseline characteristics including blood pressure and left ventricular ejection fraction (LVEF). Compared to controls, patients with ESUS had lower mean early diastolic (E′) and systolic (S′) mitral annular velocities and a higher ratio of the peak velocity of early diastolic transmitral flow to the peak velocity of early diastolic mitral annular motion (all p<0.01). The peak velocity flow in the late diastole (A wave) value and LV mass indexed to the body surface area (LVMI) (g/m2) were higher in the ESUS group than in the control group (both p<0.01). The isovolumetric relaxation time (IVRT) was longer and the mean left atrial volume index (LAVI) was higher in ESUS patients compared to the control group. Parameters of arterial stiffness such as augmentation pressure, augmentation index, and augmentation index adjusted to a heart rate of 75 bpm (AIx75) were higher in ESUS patients compared to controls (p<0.05). Patients in the ESUS group had higher levels of asymmetric dimethylarginine, interleukin 6, and N-terminal probrain natriuretic peptide (NT-proBNP, all p<0.05) than those in the control group. In multivariate analysis, the following factors were significantly associated with the presence of ESUS: AIx75 (odds ratio (OR) 1.095, 95% confidence interval (CI) 1.004-1.194; p=0.04), IVRT (OR 1.045, 95% CI: 1.009-1.082; p=0.014), LAVI (OR 1.3, 95% CI: 1.099-1.537; p=0.002), and NT-proBNP (OR 1.003, 95% CI: 1.001-1.005; p=0.005). Conclusions. Increased arterial stiffness and indices of diastolic dysfunction as well as a higher NT-proBNP level are significantly associated with ESUS. These parameters require further scrutiny over time to understand their impact on the development of symptomatic heart failure. The ClinicalTrials.gov identifier is NCT03377465.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%