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Clinical, Imaging, and Atrial Cardiopathy Markers in Ischemic Stroke Subtypes - Clues to a Cardioembolic Source
Sapna Erat Sreedharan1, Kakarla Saikiran2, S C Chandralekha1
1Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
Insights
Elevated NT-pro-BNP and chronic non-lacunar infarcts help identify cardioembolic stroke sources. These atrial cardiopathy markers are key for diagnosing embolic stroke origins.
Area of Science:
- Cardiology
- Neurology
- Biomarkers
Background:
- Cryptogenic strokes represent 20-25% of ischemic strokes.
- Atrial cardiopathy markers are more common in embolic stroke of undetermined source (ESUS) than non-embolic stroke.
- Further study is needed to understand individual marker utility in predicting cardioembolic sources.
Purpose of the Study:
- To investigate clinical, imaging, and atrial cardiopathy markers in large artery atherosclerosis (LAA), cardioembolism (CE), and cryptogenic ESUS subtypes.
- To determine the role of these markers in predicting CE etiology.
Main Methods:
- Prospective observational study of 255 ischemic stroke patients.
- Collected data on clinical profiles, risk factors, imaging, NT-pro-BNP levels, ECG parameters (PTFV1, P wave duration, PR interval), and echocardiogram parameters (LA diameter, LA volume).
- Analyzed associations between markers and etiological subtypes.
Main Results:
- Elevated NT-pro-BNP (43.95%) was the most prevalent atrial cardiopathy marker.
- NT-pro-BNP and left atrial enlargement strongly predicted CE etiology compared to LAA.
- Chronic non-lacunar infarcts and elevated NT-pro-BNP were associated with CE compared to cryptogenic strokes.
Conclusions:
- NT-pro-BNP and chronic non-lacunar infarcts are valuable for identifying cardioembolic sources in embolic stroke patients.
- These biomarkers aid in recognizing cardioembolic origins.
Background And Objectives:
Cryptogenic strokes account for 20%-25% of all ischemic strokes. Although atrial cardiopathy markers are more prevalent in the cryptogenic embolic stroke of undetermined source (ESUS) subgroup than in the nonembolic stroke subgroup, the utility of individual parameters in predicting cardioembolic sources needs to be studied further. We studied the clinical, imaging, and atrial cardiopathy markers in three ischemic stroke subtypes - large artery atherosclerosis (LAA), cardioembolism (CE), and cryptogenic ESUS - and their role in predicting the source of CE.
Methods:
This was a prospective observational study of ischemic stroke patients at Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum from April 2021 to December 2022. Clinical and risk factor profiles, imaging details, atrial cardiopathy marker (N-terminal pro-brain natriuretic peptide [NT-pro-BNP]) levels, electrocardiogram (ECG) parameters (P terminal force of V1 [PTFV1], P wave duration, the PR interval), and transthoracic echo parameters (left atrial [LA] diameter and LA volume) were collected. Associations were made between clinical, imaging, and atrial cardiopathy markers and etiological subtypes.
Results:
We had 255 participants (LAA- 98, CE- 41, and ESUS- 139) with a mean age of 63.53 years. Among the atrial cardiopathy markers, the most prevalent was elevated NT-pro-BNP (43.95%), followed by the ECG markers P wave duration (30.92%) and PTFV1 (28.74%), and LA diameter greater than 37 mm (24.27%) and LA volume greater than 34 ml/m 2 (20.31%). Among the atrial cardiopathy markers, NT-pro-BNP and LA enlargement were strongly predictive of CE etiology, when compared to LAA. Chronic non-lacunar infarcts on imaging and elevated NT-pro-BNP showed a strong association with CE, when compared to cryptogenic strokes.
Conclusions:
The atrial cardiopathy biomarker NT-pro-BNP and chronic non-lacunar infarcts can serve as useful tools for recognizing cardioembolic sources among patients with embolic strokes.
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