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Published on: February 26, 2013
Left Atrial Dilation and Risk of One-Year Readmission after Embolic Stroke of Undetermined Source
Vikrant Jagadeesan1, Austin Culver1, Nisha Raiker1
1Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Division of Cardiology, Department of Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Insights
Left atrial dilation on echocardiograms predicts 1-year hospital readmission in embolic stroke of undetermined source (ESUS) patients. This finding highlights the importance of assessing atrial cardiopathy in ESUS for better patient outcomes.
Area of Science:
- Cardiology
- Neurology
- Stroke Medicine
Background:
- Left atrial and ventricular abnormalities on ECG and TTE are linked to poor outcomes in ischemic stroke.
- The prognostic value of these abnormalities in embolic stroke of undetermined source (ESUS) remains understudied.
- ESUS represents a significant stroke subtype with distinct pathophysiology.
Purpose of the Study:
- To evaluate the predictive impact of left atrio-ventricular abnormalities on ECG and TTE.
- To assess their association with 1-year hospital readmission rates in ESUS patients.
- To contribute to understanding ESUS pathophysiology and management.
Main Methods:
- Analysis of 369 ESUS patients with at least 1 year of follow-up from a US prospective stroke registry.
- Examination of left atrio-ventricular findings on ECG and TTE, demographics, and clinical characteristics at index admission.
- Utilized Kaplan-Meier curves, log-rank tests, and Cox regression to determine time to 1-year hospital readmission.
Main Results:
- Left atrial dilation on TTE was significantly associated with increased 1-year hospital readmission (HR 1.51; 95% CI, 1.04-2.21).
- Recurrent ischemic stroke and cardiovascular causes accounted for 60% of all readmissions.
- Bundle branch block, pathologic Q-wave, and troponin elevation did not show significant association with readmission.
Conclusions:
- Left atrial dilation on TTE is a predictor of 1-year hospital readmission in ESUS patients.
- Cardiovascular events, cerebrovascular ischemic events, and heart failure were significant contributors to readmissions.
- Further research into atrial cardiopathy in ESUS is warranted.
Background:
Structural left atrial and ventricular abnormalities on the electrocardiogram (ECG) and transthoracic echocardiogram (TTE) at the time of ischemic stroke have been associated with morbidity and mortality. Yet, the prognostic impact of the same in embolic stroke of undetermined source (ESUS), a relevant subtype of ischemic stroke with a unique pathophysiology, has not been well studied to date. Our aim was to assess the predictive impact of left atrio-ventricular ECG and TTE abnormalities on one-year hospital readmission after ESUS from an ongoing single center prospective stroke registry in the U.S.
Methods:
We identified 369 ESUS patients who had at least 1 year of complete follow-up between 2013 and 2018. We examined the association of abnormal left atrio-ventricular findings on ECG and TTE, as well as basic demographic and clinical characteristics, measured at index admission with time to 1-year hospital readmission using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards regression.
Results:
Recurrent ischemic stroke and cardiovascular causes constituted 60% of all readmissions. Patients with left atrial dilation on TTE were more likely to readmitted within 1 year (HR 1.51; 95% CI, 1.04-2.21). Bundle branch block, pathologic Q-wave, and troponin elevation curves diverged, but were not significantly associated with readmission (log-rank p=0.34, p=0.08, p=0.42, respectively).
Conclusions:
Following ESUS, left atrial dilation on TTE was associated with 1-year overall hospital readmission, of which cardiovascular and cerebrovascular ischemic events, and heart failure were a notable proportion. Our data support ongoing studies of atrial cardiopathy in ESUS patients.
