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Published on: September 22, 2020
Arterial Hypertension and Its Consequences Are the Main Predictors of Embolic Stroke of Undetermined Source
Alexander B Berdalin1, Daria D Namestnikova1,2, Elvira A Cherkashova1,2
1Federal Center of Brain Research and Neurotechnologies, Federal Medical Biological Agency, Moscow 117513, Russia.
Insights
Arterial hypertension (AH) and elevated pulmonary arterial systolic pressure (PASP) are key predictors of Embolic Stroke of Undetermined Source (ESUS). Controlling AH is crucial for preventing ESUS.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Embolic Stroke of Undetermined Source (ESUS) presents a significant clinical challenge due to its complex etiology.
- Identifying reliable predictors for ESUS is crucial for effective primary and secondary prevention strategies.
Purpose of the Study:
- To identify predictors of ESUS through a hospital-based prospective cohort study.
- To develop a predictive model for ESUS incorporating demographic, clinical, and instrumental data.
Main Methods:
- A prospective cohort study involving 1,317 participants was conducted.
- Propensity score matching was used to balance age and sex between patient and control groups.
- Multivariate analysis using binary logistic regression generated the predictive model.
Main Results:
- Key predictors identified include arterial hypertension (AH), elevated pulmonary arterial systolic pressure (PASP), conduction disturbances, cardiac chamber enlargement, increased intima-media thickness (IMT), lower cognitive scores (MoCA), and brain imaging findings (microbleeds, atrophy).
- The final predictive model highlighted AH (OR=12.98), PASP (OR=1.13), and male sex (OR=2.77) as significant risk factors.
- The logistic regression model demonstrated good fit with a Nagelkerke's R-squared of 0.404.
Conclusions:
- Arterial hypertension and its sequelae are strongly associated with ESUS.
- Emphasizing rigorous control of arterial hypertension is vital for both primary and secondary prevention of ESUS.
Methods:
We performed a hospital-based prospective cohort study with 1,317 enrolled participants. We compared patients and healthy volunteers according to the main demographic, anthropometric parameters, stroke risk factors, comorbidities, and data of clinical and instrumental examination. In order to balance the study and the control groups for age and sex, the propensity score matching was performed. In order to generate the overall predictive model, a multivariate analysis was performed using the binary logistic regression method.
Results:
The following predictors of ESUS were identified in current study: arterial hypertension (AH); increased heart rate and pulmonary arterial systolic pressure (PASP); the presence of conduction disturbance; the enlargement of left, right atrium, and left ventricle end-systolic length; increased intima-media thickness (IMT) in right and left common carotid artery (CCA); lowered Montreal Cognitive Assessment (MoСA) cognitive scale score; the presence of subcortical microbleeds; central brain atrophy; the larger size of third ventricle; and the higher medial temporal lobe atrophy (MTA) score. The following risk factors were included in the final predictive model: the presence of AH (p < 0.0005; OR = 12.98 (95% CI: 4.53-37.21)) and PASP (p=0.018; OR = 1.13 (95% CI: 1.02-1.25)) and male sex (p=0.046; OR = 2.771 (95% CI: 1.017-7.555)). The Nagelkerke's pseudo-R-squared value was 0.404 and the significance of the Hosmer-Lemeshow test was 0.733, which indicate the goodness of the final logistic regression model.
Conclusions:
We propose that AH and its consequences are the main predictors of ESUS. The results of this study emphasize the importance of AH control for primary and secondary prevention of ESUS.
