Partitioning risk factors for embolic stroke of undetermined source using exploratory factor analysis

Area of Science:

• Cardiology
• Neurology
• Stroke Research

Background:

• Embolic stroke of undetermined source (ESUS) represents a significant portion of all strokes.
• ESUS patients often differ from other stroke groups, being younger with fewer traditional risk factors.
• Global variations in ESUS populations complicate understanding its clinical profile.

Purpose of the Study:

• To identify unique risk factor patterns in ESUS patients.
• To differentiate ESUS risk factors from those in other stroke types.
• To explore potential embolic sources within the heart and aorta in ESUS.

Main Methods:

• Pair matching ESUS patients (n=331) with other stroke patients (n=331) on age, sex, and ethnicity.
• Applying exploratory factor analysis to 14 clinical and risk factors.
• Identifying latent factors associated with stroke etiology in both groups.

Main Results:

• Two distinct latent factors were identified in ESUS patients.
• ESUS factors were predominantly cardiac-related: left ventricular wall motion abnormalities, reduced ejection fraction, increased left atrial volume index.
• Aortic arch atherosclerosis was also a significant factor in ESUS, clustering with cardiac variables.
• In contrast, other stroke groups were characterized by traditional risk factors.

Conclusions:

• ESUS exhibits a distinct risk factor profile compared to other strokes.
• Left ventricular wall motion abnormalities and altered left heart function are potential embolic sources in ESUS.
• The association between aortic arch atherosclerosis and cardiac factors suggests a potential causal pathway for ESUS.