Related Experiment Videos
[Multidisciplinary study of cerebrovascular disorders. II. Cardiovascular profile of occlusive vascular disorders]
1Depto Enfermedades Cardiovasculares, Medicina Interna, Radiología y Neurología, Facultad de Medicina, Pontificia Universidad Católica, Santiago de Chile.
Insights
Heart disease significantly impacts stroke risk, with specific cardiac profiles differentiating embolic from non-embolic ischemic strokes. Identifying these profiles aids in developing targeted preventive strategies for stroke patients.
Area of Science:
- Cardiology
- Neurology
- Geriatrics
Context:
- Ischemic stroke is a leading cause of death and disability, especially in older adults.
- Heart conditions, such as atrial fibrillation, are known risk factors for ischemic stroke.
- Understanding the cardiac differences between stroke types is crucial for prevention.
Purpose:
- To investigate the distinct clinical and non-invasive cardiac profiles of embolic versus non-embolic ischemic stroke patients.
- To identify independent predictors for embolic and non-embolic stroke subtypes.
Summary:
- A study of 186 ischemic stroke patients revealed significant differences in cardiac profiles between embolic (GI) and non-embolic (GII) groups.
- Embolic stroke patients showed higher rates of valvular heart disease, atrial fibrillation, and left atrial enlargement.
- Non-embolic stroke patients had more frequent absence of heart disease, EKG ST-T changes, left ventricular hypertrophy, and ventricular ectopy.
Impact:
- Age over 70, valvular heart disease, and chronic or paroxysmal atrial fibrillation are key predictors of embolic stroke.
- Left ventricular hypertrophy and frequent ventricular premature beats predict non-embolic occlusive stroke.
- These findings underscore the importance of cardiac assessment in stroke prevention and management.
Abstract:
Ischemic stroke constitute a mayor cause of morbidity and mortality in the adult population, particularly in the elderly. Heart disease may predispose to ischemic stroke, especially in the presence of transient or permanent precipitating factors such as atrial fibrillation. To elucidate the role of heart disease in predisposing to ischemic stroke we studied the clinical and non invasive cardiac profile (EKG, 2D-Echo, Holter) of 186 consecutive patients, 91 of them embolic (GI) and 96 non embolic (lacunar, atherothrombotic, others) (GII), as determined by brain CT scan and thorough clinical evaluation. Age and male/female ratio were significantly different (71 + 13 vs 65 + 12 years, 40/60 vs 65/35, p < 0.003). Hypertension was equally common in both groups (38 and 40%). Patients in GI had higher prevalence of valvular heart disease (23 vs 1%), atrial fibrillation (67 vs 10%), 2D Echo left atrial enlargement (45 vs 16%) and supraventricular ectopy in Holter (59 vs 32%) p < 0,001. By contrast absence of heart disease (45 vs 19%), ST-T changes in EKG (28 vs 14%), left ventricular hypertrophy in 2D Echo (28 vs 9%) and ventricular ectopy in Holter (54 vs 23%) were more prevalent in GII patients, p < 0.001. Multiple stepwise logistic regression analysis showed age > 70 years (relative risk (RR) 1.67), valvular heart disease (RR 2.25), chronic AF (RR 2.44) and paroxysmal AF (RR 1.89) were significant independent predictors of embolic stroke, whereas the presence of left ventricular hypertrophy in 2D-Echo (RR 0.76) and frequent ventricular premature beats in Holter (RR 0.47) were predictors of occlusive non embolic stroke. Thus, the clinical and non invasive cardiac profile of embolic and non embolic ischemic stroke is significantly different, which is relevant to preventive strategies.