Jani Pirinen1, Jukka Putaala2, Aapo L Aro3, Ida Surakka4, Anita Haapaniemi5, Markku Kaste2, Elena Haapaniemi2, Turgut Tatlisumak6, Mika Lehto3. 1. Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland. Electronic address: jani.pirinen@helsinki.fi. 2. Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland. 3. Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland. 4. Institute for Molecular Medicine Finland FIMM, University of Helsinki, Finland. 5. Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland; University of Eastern Finland, Faculty of Medicine, Finland. 6. Department of Neurology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
Abstract
BACKGROUND: The diagnostic work-up to reveal etiology in a young ischemic stroke (IS) patient includes evaluation for high-risk source of cardioembolism (HRCE), since this subtype associates with high early recurrence rate and mortality. We investigated the association of ECG findings with a final etiologic subgroup of HRCE in a cohort of young patients with first-ever IS. METHODS: The Helsinki Young Stroke Registry includes IS patients aged 15 to 49 years admitted between 1994 and 2007. Blinded to other clinical data, we analyzed a 12-lead resting ECG obtained 1-14 days after the onset of stroke symptoms in 690 patients. We then compared the ECG findings between a final diagnosis of HRCE (n=78) and other/undetermined causes (n=612). We used multivariate logistic regression to study the association between ECG parameters and HRCE. RESULTS: Of our cohort (63% male), 35% showed ECG abnormality, the most common being T-wave inversion (16%), left ventricular hypertrophy (14%), prolonged P-wave (13%), and prolonged QTc (12%). 3% had atrial fibrillation (AF), and 4% P-terminal force (PTF). Of the continuous parameters, longer QRS-duration, QTc, and wider QRS-T-angle independently associated with HRCE. After AF, PTF had the strongest independent association with HRCE (odds ratio=44.32, 95% confidence interval=[10.51-186.83]), followed by a QRS-T angle >110° (8.29 [3.55-19.32]), T-wave inversion (5.06, 2.54-10.05), and prolonged QTc (3.02 [1.39-6.56]). CONCLUSION: Routine ECG provides useful information for directing the work-up of a young IS patient. In addition to AF, PTF in particular showed a strong association with etiology of HRCE.
BACKGROUND: The diagnostic work-up to reveal etiology in a young ischemic stroke (IS) patient includes evaluation for high-risk source of cardioembolism (HRCE), since this subtype associates with high early recurrence rate and mortality. We investigated the association of ECG findings with a final etiologic subgroup of HRCE in a cohort of young patients with first-ever IS. METHODS: The Helsinki Young Stroke Registry includes IS patients aged 15 to 49 years admitted between 1994 and 2007. Blinded to other clinical data, we analyzed a 12-lead resting ECG obtained 1-14 days after the onset of stroke symptoms in 690 patients. We then compared the ECG findings between a final diagnosis of HRCE (n=78) and other/undetermined causes (n=612). We used multivariate logistic regression to study the association between ECG parameters and HRCE. RESULTS: Of our cohort (63% male), 35% showed ECG abnormality, the most common being T-wave inversion (16%), left ventricular hypertrophy (14%), prolonged P-wave (13%), and prolonged QTc (12%). 3% had atrial fibrillation (AF), and 4% P-terminal force (PTF). Of the continuous parameters, longer QRS-duration, QTc, and wider QRS-T-angle independently associated with HRCE. After AF, PTF had the strongest independent association with HRCE (odds ratio=44.32, 95% confidence interval=[10.51-186.83]), followed by a QRS-T angle >110° (8.29 [3.55-19.32]), T-wave inversion (5.06, 2.54-10.05), and prolonged QTc (3.02 [1.39-6.56]). CONCLUSION: Routine ECG provides useful information for directing the work-up of a young IS patient. In addition to AF, PTF in particular showed a strong association with etiology of HRCE.
Authors: Yan Hou; Kathleen A Ryan; Carolyn A Cronin; Elizabeth M Aradine; John W Cole; Seemant Chaturvedi; Marcella A Wozniak; Prachi Mehndiratta; Michael S Phipps; Karen L Yarbrough; Mohammad Yousaf; Steven J Kittner Journal: J Stroke Cerebrovasc Dis Date: 2022-07-04 Impact factor: 2.677
Authors: Jani Pirinen; Jukka Putaala; Karoliina Aarnio; Aapo L Aro; Satu Mustanoja; Juha Sinisalo; Markku Kaste; Elena Haapaniemi; Turgut Tatlisumak; Mika Lehto Journal: Eur Stroke J Date: 2017-03-01
Authors: Michelle C Johansen; Henrique Doria de Vasconcellos; Saman Nazarian; Joao A C Lima; Rebecca F Gottesman Journal: J Am Heart Assoc Date: 2021-01-14 Impact factor: 5.501