Diastolic function in young patients with cryptogenic stroke: A case-control pilot study
Jani Pirinen1, Jouni Kuusisto2, Vesa Järvinen1
1HUS Medical Imaging Center, Clinical Physiology and Nuclear Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Insights
Advanced echocardiography revealed subtle diastolic function differences in young cryptogenic stroke patients compared to controls. These findings suggest potential subclinical heart disease in a subgroup of these patients.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Cryptogenic ischemic stroke in young individuals often lacks a clear cause.
- Investigating subclinical cardiac abnormalities is crucial for understanding stroke etiology.
- Pilot study to explore diastolic function differences in young stroke patients.
Purpose of the Study:
- To compare diastolic function between young cryptogenic stroke patients and healthy controls using advanced echocardiography.
- To identify potential cardiac markers associated with early-onset cryptogenic stroke.
- To explore if subclinical cardiac abnormalities are present in a subset of young stroke patients.
Main Methods:
- Recruited 30 young cryptogenic ischemic stroke patients (18-49 years) and 30 age/sex-matched controls.
- Measured diastolic function using speckle tracking strain rate, Doppler, and 4D volumetry.
- Analyzed differences, including comparisons of the lowest tertiles for each parameter.
Main Results:
- No patients or controls met criteria for overt diastolic dysfunction.
- Stroke patients showed lower E/A ratio, lateral/mean e', A/a' ratio, early diastolic strain rate, and speckle tracking e/a ratio.
- Lowest tertile analysis revealed lower peak filling rate, peak early filling fraction, and tissue Doppler velocities in patients.
Conclusions:
- Subtle diastolic function differences exist between young cryptogenic stroke patients and controls.
- These subtle differences may contribute to the pathogenesis of early-onset cryptogenic stroke.
- Comparison of lowest tertiles highlights a potential subgroup with subclinical heart disease.
Background:
Ischaemic stroke in young individuals often remains cryptogenic. In this pilot study, we investigated, whether advanced echocardiography methods could find differences in the diastolic function between young cryptogenic stroke patients and stroke-free controls.
Methods:
We recruited 30 cryptogenic ischaemic stroke patients aged 18-49 and 30 age- and sex-matched stroke-free controls among participants of the Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome (SECRETO) study (NCT01934725). We measured diastolic function parameters derived from speckle tracking strain rate, Doppler techniques and 4D volumetry. We also performed statistical analyses comparing only the highest and lowest tertile of cases and controls for each parameter.
Results:
None of our patients or controls had diastolic dysfunction according to ASE/EACVI criteria. However, compared to stroke-free controls, the stroke patient group had lower E/A ratio of mitral inflow, lower lateral and mean e', lower A/a' ratio, lower strain rate in early diastole and lower speckle tracking-derived e/a ratio. When comparing the lowest tertiles, patients also had a lower peak filling rate by 4D volumetry, a lower peak early filling fraction (fraction of left ventricular filling during early diastole), and lower velocities in a series of the tissue Doppler-derived diastolic parameters and blood flow/tissue velocity ratios.
Conclusion:
Our study displayed subtle differences in diastolic function between patients and stroke-free controls, which may play a role in early-onset cryptogenic stroke. The differences were clearer when the lowest tertiles were compared, suggesting that there is a subgroup of young cryptogenic stroke patients with subclinical heart disease.
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