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Markers of Atrial Cardiopathy in Severe Embolic Strokes of Undetermined Source
Maurizio Acampa1, Alessandra Cartocci2, Carlo Domenichelli1
1Stroke Unit, Department of Emergency-Urgency and Transplants, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General Hospital, Siena, Italy.
Insights
Severe embolic strokes of undetermined source (ESUS) are linked to older age, female sex, and atrial cardiopathy markers. Identifying these factors is crucial for appropriate patient management and therapy.
Area of Science:
- Cardiology
- Neurology
- Stroke Research
Background:
- Embolic strokes of undetermined source (ESUS) encompass diverse etiological mechanisms.
- Current ESUS definitions may be too broad, potentially masking specific underlying causes like atrial cardiopathy.
- Heterogeneous mechanisms within ESUS can influence clinical stroke severity.
Purpose of the Study:
- To investigate the association between neurological deficit severity in ESUS patients and the presence of atrial cardiopathy markers.
- To identify specific clinical characteristics associated with severe ESUS.
Main Methods:
- Retrospective analysis of 226 ESUS patients, categorized by neurological deficit severity (NIHSS ≤ 5 vs. >5).
- Evaluation of atrial cardiopathy indices including P wave dispersion, P wave characteristics, and left atrial size.
- Multivariate logistic regression to determine predictors of severe ESUS.
Main Results:
- Severe ESUS patients were older, predominantly female, and exhibited higher P wave dispersion, P wave max, P wave index, and left atrial size compared to mild ESUS.
- An abnormal P wave axis was more frequent in the severe ESUS group.
- Multivariate analysis identified age, female sex, and P wave dispersion as significant predictors of severe ESUS.
Conclusions:
- Atrial cardiopathy markers are associated with increased neurological deficit severity in ESUS.
- These findings suggest atrial cardiopathy may play a pathogenic role in a specific subgroup of severe ESUS patients.
- Early detection of atrial fibrillation in these patients is critical for optimal therapeutic strategies.
Background And Purpose:
The current definition of embolic strokes of undetermined source (ESUS) seems to be too broad, including strokes due to heterogeneous mechanisms, such as atrial cardiopathy and other occult cardiac conditions, aortic arch plaques, and non-stenosing atherosclerosis, that can be differently associated with clinical stroke severity at the time of presentation. The aim of our study was to assess the possible association between neurological deficit severity and presence of markers of atrial cardiopathy in ESUS.
Methods:
We retrospectively reviewed the medical records of a cohort of 226 ESUS patients (105 M, 121 F), that were divided into two groups according to the severity of neurological deficit (99 mild strokes with NIHSS ≤ 5 and 127 severe strokes with NIHSS >5). The following indices of atrial cardiopathy were evaluated: P wave dispersion, P wave max, P wave min, P wave mean, P wave index, P wave axis, left atrial size.
Results:
Patients with severe ESUS were significantly older (74 ± 12 vs. 67 ± 14 years, P < 0.001) and female sex was prevalent (67 vs. 36%, P > 0.001); they had higher values of P-wave-dispersion (51 ± 14 vs. 46 ± 13, P = 0.01), P-wave-max (131 ± 20 vs. 125 ± 15 ms, P = 0.01), P-wave-index (16 ± 5 vs. 15 ± 5 ms, P = 0.01), left atrial size (20 ± 6 vs. 18 ± 4 cm2, P = 0.01), left atrial volume index (31 ± 14 vs. 27 ± 11 ml/m2, P = 0.04), in comparison with mild ESUS. An abnormal P wave axis was detected more frequently in severe ESUS (21 vs. 9%, P = 0.01). Furthermore, multivariate logistic regression showed that age (OR = 1.21 for each 5-year increase, 95% CI 1.09-1.35), sex (OR = 3.24 for female sex, 95% CI 1.82-5.76) and PWD (OR = 1.32 for each 10-ms increase, 95% CI 1.07-1.64) were the best subset of associated variables for severe ESUS.
Conclusions:
Our findings shed light on specific clinical characteristics of severe ESUS including the presence of atrial cardiopathy that could play a pathogenic role in this subgroup of patients. Searching for atrial fibrillation in these patients is especially important to perform the most appropriate therapy.
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