Left Atrial Appendage Flow Velocity and Multiple Infarcts in Cryptogenic Stroke.
Aged
Aged, 80 and over
Atrial Appendage
/ diagnostic imaging
Atrial Function, Left
Echocardiography, Doppler, Pulsed
Echocardiography, Transesophageal
Embolic Stroke
/ diagnostic imaging
Female
Heart Diseases
/ complications
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Retrospective Studies
Risk Assessment
Risk Factors
Cryptogenic stroke
Ischemic stroke
Left atrial appendage
Magnetic resonance imaging
Transesophageal echocardiography
Ultrasound
Journal
Cerebrovascular diseases (Basel, Switzerland)
ISSN: 1421-9786
Titre abrégé: Cerebrovasc Dis
Pays: Switzerland
ID NLM: 9100851
Informations de publication
Date de publication:
2021
2021
Historique:
received:
06
12
2020
accepted:
20
01
2021
pubmed:
31
3
2021
medline:
10
8
2021
entrez:
30
3
2021
Statut:
ppublish
Résumé
To validate the hypothesis that cryptogenic stroke with multiple infarcts included embolic stroke due to left atrial appendage (LAA) dysfunction, the present retrospective observational study was aimed to clarify the association between LAA flow velocity (LAA-FV) and multiple infarcts in patients with cryptogenic stroke. From consecutive patients with cryptogenic stroke admitted to our hospital within 7 days after onset, patients without brain magnetic resonance imaging (MRI) on admission or without transesophageal echocardiography (TEE) during acute hospitalization were excluded, and the remaining patients were enrolled. Multiplicity of fresh infarcts was assessed using diffusion-weighted images from brain MRI. LAA-FV was defined as LAA peak emptying flow velocity on TEE. Of 786 enrolled patients, 522 patients (66%) had a single infarct, and the remaining 264 patients (34%) had multiple infarcts. The percentage of multiple infarcts decreased with increasing quartiles of LAA-FV (p for trend <0.001). The adjusted odds ratio for multiple infarcts decreased with increasing quartiles of LAA-FV (adjusted odds ratio in the fourth quartile, 0.39; 95% confidence interval, 0.25-0.60; compared with the first quartile). LAA-FV as a continuous variable was negatively associated with multiple infarcts (adjusted odds ratio per 10 cm/s, 0.87; 95% confidence interval, 0.81-0.92). Reduced LAA-FV on TEE was associated with multiple infarcts in patients with cryptogenic stroke. The present findings indicate that cryptogenic stroke with multiple infarcts includes embolic stroke due to LAA dysfunction.
Sections du résumé
BACKGROUND
To validate the hypothesis that cryptogenic stroke with multiple infarcts included embolic stroke due to left atrial appendage (LAA) dysfunction, the present retrospective observational study was aimed to clarify the association between LAA flow velocity (LAA-FV) and multiple infarcts in patients with cryptogenic stroke.
METHODS
From consecutive patients with cryptogenic stroke admitted to our hospital within 7 days after onset, patients without brain magnetic resonance imaging (MRI) on admission or without transesophageal echocardiography (TEE) during acute hospitalization were excluded, and the remaining patients were enrolled. Multiplicity of fresh infarcts was assessed using diffusion-weighted images from brain MRI. LAA-FV was defined as LAA peak emptying flow velocity on TEE.
RESULTS
Of 786 enrolled patients, 522 patients (66%) had a single infarct, and the remaining 264 patients (34%) had multiple infarcts. The percentage of multiple infarcts decreased with increasing quartiles of LAA-FV (p for trend <0.001). The adjusted odds ratio for multiple infarcts decreased with increasing quartiles of LAA-FV (adjusted odds ratio in the fourth quartile, 0.39; 95% confidence interval, 0.25-0.60; compared with the first quartile). LAA-FV as a continuous variable was negatively associated with multiple infarcts (adjusted odds ratio per 10 cm/s, 0.87; 95% confidence interval, 0.81-0.92).
CONCLUSIONS
Reduced LAA-FV on TEE was associated with multiple infarcts in patients with cryptogenic stroke. The present findings indicate that cryptogenic stroke with multiple infarcts includes embolic stroke due to LAA dysfunction.
Identifiants
pubmed: 33784670
pii: 000514672
doi: 10.1159/000514672
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
429-434Informations de copyright
© 2021 S. Karger AG, Basel.