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

Abstract

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.

Paroxysmal Atrial Fibrillation in Cryptogenic Stroke Patients With Major-Vessel Occlusion

“…Several factors are thought to be predictors of latent AF in CS: increased age ( 18 – 21 ), hypertension ( 19 ), diabetes mellitus ( 19 ), heart failure ( 19 ), higher CHADS 2 score ( 14 ), higher National Institute of Health Stroke Scale score ( 24 ), cortical or cerebellar infarcts ( 25 ), higher BNP or NT-proBNP levels ( 16 , 22 ), frequent PACs ( 15 ) and atrial run on Holter electrocardiogram ( 26 ), and larger LAD on echocardiography ( 17 , 21 ). Some classes of drugs, including angiotensin II receptor blockers, are suitable candidates for AF prevention ( 27 ).…”

Evaluation of Oxidative Status in Elderly Patients with Multiple Cerebral Infarctions and Multiple Chronic Total Coronary Occlusions

“…From 1 January 2010 to 31 December 2018, our research included the patients with multiple cerebral infarcts (MCI) and multiple chronic total coronary occlusions in different groups. The inclusion criteria adopted in this research were (1) the patients aged 55 to 87 years and (2) the patients with MCI defined as brain infarcts in multiple artery territories+one-vessel coronary lesion (OVCL) [11], MCI+two-vessel coronary lesion (TVCL), and MCI +multiple-vessel coronary lesion (MVCL). The research was approved by the Xuzhou Medical University and Human Research Ethics Committee of the University according to the relevant Chinese laws, and the written informed consents were obtained from human participants in the research according to the principles in the Revised Declaration of Helsinki.…”

“…(10) Angina pectoris (AP) is defined as the pain and discomfort in the area of the chest [32]. (11) Duration of illness (DOI) is defined as the number of years since the first hospitalization [33].…”