Differences in Endothelial Glycocalyx, Arterial Stiffness, and Left Atrial Function Among Ischemic Stroke Types

Area of Science:

• Cardiovascular Research
• Neurology
• Biomedical Engineering

Background:

• Stroke is a leading cause of disability and mortality.
• Understanding the distinct pathophysiological mechanisms underlying different ischemic stroke subtypes is crucial for effective secondary prevention.
• Previous research has focused on risk factors, but less is known about the specific cardiovascular alterations associated with each subtype.

Purpose of the Study:

• To investigate and compare arterial stiffness, endothelial glycocalyx integrity, and left atrial/ventricular deformation across different ischemic stroke subtypes and healthy controls.
• To identify specific cardiovascular biomarkers that can differentiate between stroke subtypes.

Main Methods:

• A cohort of 194 ischemic stroke patients (lacunar, large artery atherosclerotic [LAA], cardioembolic, embolic of undetermined source [ESUS]) and 50 controls were analyzed.
• Measurements included perfused boundary region (PBR4-25) for endothelial glycocalyx, pulse wave velocity (PWV) and central systolic blood pressure (cSBP) for arterial stiffness, left ventricular global longitudinal strain (LVGLS), and left atrial (LA) strains.
• Ventriculoarterial interaction was assessed using the PWV/GLS ratio and myocardial work indices.

Main Results:

• Stroke patients exhibited impaired LA strains, LVGLS, Wasted Work, PBR4-25, cSBP, PWV, and PWV/GLS compared to controls.
• Significant differences were found in LA strain, PWV, PWV/GLS, and PBR4-25 among stroke subtypes.
• Lacunar strokes showed the most impaired PBR4-25, cardioembolic/ESUS strokes had the worst LA strain, and LAA strokes presented with the most affected PWV and PWV/GLS.
• Specific cut-off values were identified to discriminate between stroke subtypes: PBR4-25 (2.29 μm) for lacunar stroke, PWV (13 m/s) for LAA stroke, and LA reservoir strain (25%) for ESUS/Cardioembolic strokes.

Conclusions:

• Lacunar strokes are associated with excessive endothelial glycocalyx shedding.
• Large artery atherosclerotic strokes demonstrate aggravated aortic stiffness.
• Embolic stroke of undetermined source and cardioembolic strokes exhibit worse left atrial performance.
• These subtype-specific pathophysiological differences highlight the potential for tailored secondary prevention strategies in stroke management.