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Cerebral microembolism in patients with segmental left ventricular wall motion abnormalities
Aldona Warsz-Wianecka1, Anetta Lasek-Bal1, Zofia Kazibutowska1
1Dept. of Neurology, Medical University of Silesia Hospital No. 7, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland.
Insights
Microembolic signals in the middle cerebral artery are a stroke risk factor in patients with segmental left ventricular hypokinesis. High intensity signals, elevated fibrinogen, and leukocytosis are linked to cardiogenic stroke.
Area of Science:
- Cardiology
- Neurology
- Vascular Medicine
Background:
- Segmental heart wall motion abnormalities, specifically left ventricular hypokinesis due to coronary heart disease, are common.
- The association between these cardiac abnormalities and stroke risk, particularly via embolic signals, remains unclear.
Purpose of the Study:
- To compare the frequency and characteristics of embolic signals in the middle cerebral artery (MCA) in patients with segmental left ventricular hypokinesis, with and without stroke.
- To investigate the relationship between inflammatory markers, fibrinogen, dyslipidemia, and MCA microembolic signals in this patient group.
Main Methods:
- A study involving 68 patients with segmental heart hypokinesis (33 without stroke, 35 with stroke) and 37 healthy controls.
- Utilized echocardiography and carotid/transcranial Doppler for microembolic signal detection.
- Assessed inflammatory markers (ESR, leukocyte count) and lipid profiles (triglycerides, total cholesterol, HDL, LDL) in patient groups.
Main Results:
- Embolic signals were significantly more frequent in patients with segmental heart hypokinesis compared to controls.
- Patients with stroke exhibited a higher incidence of embolic signals, high-intensity signals, distal intraventricular septum hypokinesis, elevated cholesterol, LDL, and triglycerides.
- Increased fibrinogen levels and leukocytosis correlated with a higher detection rate of embolic signals.
Conclusions:
- Embolic signals in the MCA of patients with segmental left ventricular hypokinesis should be recognized as a stroke risk factor.
- Hypokinesis of the intraventricular septum, high-intensity embolic signals, elevated serum fibrinogen, and leukocytosis are associated with cardiogenic stroke, suggesting their etiological importance.
Background And Purpose:
The significance of segmental heart wall motion abnormalities for stroke is unknown. The aims of the study included (1) comparison of the frequency and type of embolic signals in the middle cerebral artery in patients with segmental left ventricular wall hypokinesis due to coronary heart disease with and without stroke, and (2) determination of the relationship between inflammatory parameters, fibrinogen level, dyslipidemia and microembolic signals in the middle cerebral artery in patients with segmental heart hypokinesis.
Material And Methods:
The study included 68 patients with segmental heart hypokinesis (33 without stroke [group I] and 35 with stroke [group II]), as well as 37 healthy volunteers and a reference group of 30 patients. Echocardiography and carotid/transcranial Doppler with detection of microembolic signals were performed. Patients from group I and II had erythrocyte sedimentation rate, leucocyte count, triglycerides, total cholesterol, HDL, and LDL examined.
Results:
Embolic signals were detected in patients with segmental heart hypokinesis significantly more frequently than in the control and reference groups. The high number of embolic signals, signals of high intensity, hypokinesis of the distal part of the intraventricular septum, increased cholesterol levels, LDL and triglycerides were all found more frequently in patients from group II than in group I. Embolic signals were detected more frequently in patients with high fibrinogen levels and leukocytosis.
Conclusions:
Embolic signals in the middle cerebral artery in patients with segmental left ventricular hypokinesis have to be considered as a risk factor of stroke. The following changes are observed in patients with cardiogenic stroke: hypokinetic intraventricular septum, high intensity embolic signals, increased serum fibrinogen levels and leucocyte count. It may indicate the importance of these factors in the aetiology of stroke.
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