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Biomarkers of Cardiac Dysfunction as Risk Factors in Cryptogenic Stroke
Yohei Tateishi1, Tadashi Kanamoto2, Kairi Yamashita2
1Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan, ytate@nagasaki-u.ac.jp.
Insights
Biomarkers like brain natriuretic peptide (BNP) and E/e' may indicate cardiac dysfunction in cryptogenic stroke (CS) patients without large patent foramen ovale (PFO). These findings help differentiate CS causes.
Area of Science:
- Cardiology
- Neurology
- Biomarkers
Background:
- The association between cardiac dysfunction biomarkers and cryptogenic stroke (CS) remains unclear.
- Investigating these biomarkers is crucial for understanding CS etiology.
Purpose of the Study:
- To determine if cardiac dysfunction biomarkers are associated with cryptogenic stroke (CS).
- To compare these biomarkers between CS patients (with and without large patent foramen ovale [PFO]) and other ischemic stroke subtypes.
Main Methods:
- Retrospective evaluation of 1,514 ischemic stroke patients.
- Transthoracic echocardiography for left atrial diameter and E/e' (early diastolic mitral inflow/mitral annular velocity).
- Transesophageal echocardiography for PFO and left atrial appendage (LAA) flow velocity; assessment of brain natriuretic peptide (BNP).
Main Results:
- CS was diagnosed in 264 patients; 17% had large PFOs.
- CS patients without large PFO showed higher BNP and E/e', and lower LAA flow velocity compared to noncardioembolic stroke subtypes.
- Specific cutoff values were identified for BNP, E/e', and LAA flow velocity to distinguish CS without large PFO.
Conclusions:
- Cardiac dysfunction biomarkers, including BNP and E/e', are associated with cryptogenic stroke (CS) in patients without large patent foramen ovale (PFO).
- These biomarkers can help differentiate CS from other stroke causes, aiding in etiological diagnosis.
Background:
It is unclear whether biomarkers of cardiac dysfunction are associated with cryptogenic stroke (CS).
Methods:
We retrospectively evaluated consecutive ischemic stroke patients. Patients underwent transthoracic echocardiography to evaluate left atrial diameter and the peak transmitral filling velocity/mean mitral annular velocity during early diastole (E/e'). Patent foramen ovale (PFO) and left atrial appendage flow velocity were evaluated by transesophageal echocardiography. We compared clinical characteristics and biomarkers of cardiac dysfunction (brain natriuretic peptide [BNP], left atrial diameter, E/e', and left atrial appendage flow velocity) between CS or CS without large PFO and other causative stroke subtypes.
Results:
Among 1,514 patients with ischemic stroke, 264 patients were classified as having CS. Of these, transesophageal echocardiography revealed 27/158 (17%) large PFOs. In comparison, for the noncardioembolic stroke group, which consisted of large artery and small vessel subtypes, patients with CS without large PFO had higher log10 BNP (adjusted OR 2.70; 95% CI 1.92-3.78; p < 0.001), higher log10 E/e' (3.41; 1.21-13.15; p = 0.019), and lower left atrial appendage flow velocity (0.98; 0.97-1.00; p = 0.031). Left atrial diameter was similar for noncardioembolic stroke and CS without large PFO (p = 0.380). Cutoff values of BNP, E/e', and left atrial appendage flow velocity capable of distinguishing CS without large PFO from noncardioembolic stroke were 65.0 pg/mL (sensitivity 55.3%; specificity 70.9%), 13.0 (45.5%; 68.0%), and 46.0 cm/s (37.1%; 87.5%), respectively.
Conclusion:
Patients with CS without large PFO could have biomarkers of cardiac dysfunction.
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