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Evidence of subtle left ventricular systolic dysfunction in cryptogenic stroke in the young

Jani Pirinen1, Jouni Kuusisto2, Nicolas Martinez-Majander3

  • 1HUS Medical Imaging Center, Clinical Physiology and Nuclear Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Echocardiography (Mount Kisco, N.Y.)
|January 23, 2021
PubMed

Insights

Young patients with cryptogenic ischemic stroke show subtle heart function changes. Longitudinal strain analysis revealed reduced global longitudinal strain, suggesting the heart may contribute to stroke causes.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Imaging

Background:

  • Cryptogenic ischemic stroke in young adults often lacks an identifiable cause.
  • The heart is a potential, yet under-investigated, source of stroke in this demographic.
  • Left ventricular (LV) dynamic volumetry and strain analysis offer novel insights into LV function.

Purpose of the Study:

  • To investigate subtle differences in left ventricular systolic function between young cryptogenic ischemic stroke patients and healthy controls.
  • To evaluate the utility of advanced echocardiographic techniques, including LV volumetry and strain analysis, in identifying cardiac abnormalities associated with cryptogenic stroke.

Main Methods:

  • A pilot study involving 30 young patients (18-50 years) with cryptogenic ischemic stroke and 30 matched controls.
  • Assessment of LV systolic function using LV volumetry (ejection fraction, peak emptying rate, time to peak emptying rate).
  • Evaluation of longitudinal systolic function via speckle tracking strain/strain rate imaging and tissue velocity imaging (mitral annular displacement, septal S').

Main Results:

  • Stroke patients exhibited significantly reduced global longitudinal strain (median -18.9) compared to controls (median -20.0, P=.010).
  • No significant differences were observed in septal S', mitral annular displacement, global longitudinal strain rate, or LV volumetry parameters between groups.
  • Global longitudinal strain emerged as a sensitive indicator of altered cardiac function in this cohort.

Conclusions:

  • Young patients with cryptogenic ischemic stroke demonstrate subtly impaired systolic function, specifically in global longitudinal strain.
  • These findings suggest a potential cardiac contribution to the pathogenesis of cryptogenic ischemic stroke in younger individuals.
  • Longitudinal strain analysis may be a valuable tool for risk stratification and etiological investigation in cryptogenic stroke.
Abstract

Keywords:
echocardiographyischemic strokestrainstrain rate imagingthree-dimensional echocardiography

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