Abstract W P201: New Echocardiographic Indicator for Cardioembolic Stroke
Background: In many cardioembolic (CE) strokes, the specific embolic source might be uncertain. Despite the high mortality of CE stroke, we do not pay attention enough for the potential CE sources. Although atrial fibrillation (Af) is the most common cause of embolic sources, more complex and dynamic multiplicity of the cardiac sources may influence CE stroke. The aim of this study was to evaluate the new echocardiographic indicators which have been underestimated as low-risk CE sources.
Methods: One thousand eight hundred twelve patients with acute ischemic stroke who had a transthoracic echocardiogram during admission were identified. We classified patients into 2 groups of potential CE and non-CE. In patients with undetermined etiology, we excluded patients who had definite non-CE sources such as vasculopathy, hypercoagulable state, hematologic disorder and patients with incomplete evaluation. Thereafter, a stroke neurologist reviewed all of the magnetic resonance images.
Results: Among a total of 1812 patients, 575 (31.7%) had potential CE infarctions. About half of the patients with CE etiology had Af. Patients with potential CE etiology were more likely to have larger left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left atrial size, mitral ratio of peak early to late diastolic filling velocity (E/A) and smaller ejection fraction. After adjusting for multiple echocardiographic variables including Af, binary logistic regression demonstrated that E/A >2.0 had a significant predictive value for CE stroke (OR 3.45, 95% CI: 1.43-8.36, p<0.01). After dichotomizing by gender, the statistical significance remained only in female group. (OR 9.71, 95% CI: 1.96-48.04, p<0.01)
Conclusion: Diastolic dysfunction might be a predominant embolic source. The E/A>2.0 is a significant predictor of CE stroke and provides prognostic information incremental to left ventricular systolic function.
Author Disclosures: Y. Kim: None. C. Kim: None. S. Jung: None. T. Kim: None. S. Ko: None. B. Yoon: None. S. Lee: None.
- © 2015 by American Heart Association, Inc.