Novel echocardiographic indicator for potential cardioembolic stroke

In many cardioembolic strokes (CSs), the specific embolic source is uncertain. Despite the high mortality of CS, not enough attention is paid to its potential source. Although atrial fibrillation (AF) is the most common source of embolism, more complex and dynamic multiplicities may influence CS. The aim of this study was to evaluate novel indicators of transthoracic echocardiography (TTE) that have additional value for detecting CS.

In total, 1878 patients with acute ischaemic stroke who had TTE during admission were identified. Of the patients with undetermined etiology, 93 patients with incomplete evaluations were excluded. Thereafter, two stroke neurologists reviewed all of the magnetic resonance images to assess cardioembolic lesion patterns. The patients were classified into two groups: potential cardioembolic stroke (PCS) and non-PCS.

Amongst a total of 1601 patients, 518 (32.4%) had PCS. About half of the patients with PCS had AF. Patients with PCS were more likely to have larger left ventricular (LV) end-diastolic diameters, larger LV end-systolic diameters, larger left atrial sizes, increased E/A ratios and reduced LV ejection fractions. After adjusting for multiple clinical and TTE variables including AF, an E/A ratio ≥1.5 had a significant predictive value for PCS (odds ratio 2.89, 95% confidence interval 1.57-5.31, P < 0.01).

An E/A ratio ≥1.5 is independently associated with PCS after adjusting for multiple covariates including AF and provides incremental prognostic information for detecting PCS.