Jani Pirinen1,2,3, Antti Eranti4, Paul Knekt5, Mika Lehto1, Nicolas Martinez-Majander2, Aapo L Aro1, Harri Rissanen5, Markku Heliövaara5, Markku Kaste2, Turgut Tatlisumak2,6, Heikki Huikuri7, Jukka Putaala2. 1. a Department of Cardiology , Heart and Lung Center, Helsinki University Hospital, University of Helsinki , Helsinki , Finland. 2. b Department of Neurology, Clinical Neurosciences , Helsinki University Hospital, University of Helsinki , Helsinki , Finland. 3. c Department of Clinical Physiology and Nuclear Medicine , HUS Medical Imaging Center, Helsinki University Hospital, University of Helsinki , Helsinki , Finland. 4. d Department of Internal Medicine , Päijät-Häme Central Hospital , Lahti , Finland. 5. e Department of Health, Functional Capacity, and Welfare , National Institute for Health and Welfare (Terveyden ja Hyvinvoinnin Laitos) , Helsinki , Finland. 6. f Department of Clinical Neurosciences/Neurology , Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden. 7. g Medical Research Center Oulu , Oulu University Hospital, University of Oulu , Oulu , Finland.
Abstract
INTRODUCTION: Certain electrocardiographic (ECG) abnormalities are associated with ischemic stroke (IS), especially cardioembolic subtype. Besides atrial fibrillation, markers of left ventricular hypertrophy (LVH) or atrial pathology also reflect elevated risk. We studied the association of ECG markers with IS in young adults. METHODS: We performed a case-control study including 567 consecutive IS patients aged 15-49 years (inclusion period: 1994-2007) and one or two age- and sex-matched control subjects enrolled during 1978-1980 (n = 1033), and investigated also the stroke aetiologic subgroups. We studied ECGs of all participants for markers of atrial abnormality, i.e. P-terminal force (PTF) on lead V1, interatrial blocks (IAB; P-wave duration ≥110 ms), and LVH. Conditional logistic regression analyses were used. RESULTS: IAB (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.16-2.13) and PTF combined with LVH (HR: 6.83, 95% CI: 1.65-28.31), were independently associated with IS. LVH, abnormal P-wave (HR: 6.87, 95% CI: 1.97-135.29), PTF, IAB, and combinations of these P-wave abnormalities with LVH - were associated with cardioembolic subtype. Abnormal P-wave and IAB were associated with cryptogenic stroke subtype. In unadjusted analysis, LVH was associated with small-vessel disease subtype. CONCLUSION: P-wave abnormalities on ECG were associated with cardioembolic but also with a cryptogenic subtype of IS. Key messages ECG patterns associated with atrial pathology are markers of increased risk of ischemic stroke in young adults. The ECG markers reflecting atrial pathology were seen in patients with cardioembolic and cryptogenic subtypes of ischemic stroke.
INTRODUCTION: Certain electrocardiographic (ECG) abnormalities are associated with ischemic stroke (IS), especially cardioembolic subtype. Besides atrial fibrillation, markers of left ventricular hypertrophy (LVH) or atrial pathology also reflect elevated risk. We studied the association of ECG markers with IS in young adults. METHODS: We performed a case-control study including 567 consecutive IS patients aged 15-49 years (inclusion period: 1994-2007) and one or two age- and sex-matched control subjects enrolled during 1978-1980 (n = 1033), and investigated also the stroke aetiologic subgroups. We studied ECGs of all participants for markers of atrial abnormality, i.e. P-terminal force (PTF) on lead V1, interatrial blocks (IAB; P-wave duration ≥110 ms), and LVH. Conditional logistic regression analyses were used. RESULTS: IAB (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.16-2.13) and PTF combined with LVH (HR: 6.83, 95% CI: 1.65-28.31), were independently associated with IS. LVH, abnormal P-wave (HR: 6.87, 95% CI: 1.97-135.29), PTF, IAB, and combinations of these P-wave abnormalities with LVH - were associated with cardioembolic subtype. Abnormal P-wave and IAB were associated with cryptogenic stroke subtype. In unadjusted analysis, LVH was associated with small-vessel disease subtype. CONCLUSION: P-wave abnormalities on ECG were associated with cardioembolic but also with a cryptogenic subtype of IS. Key messages ECG patterns associated with atrial pathology are markers of increased risk of ischemic stroke in young adults. The ECG markers reflecting atrial pathology were seen in patients with cardioembolic and cryptogenic subtypes of ischemic stroke.
Entities:
Keywords:
Cardioembolism; P-wave; case-control study; cryptogenic stroke; electrocardiographic; embolic strokes of undetermined source; left ventricular hypertrophy; stroke; stroke in the young
Authors: John A Johnson; Kazi T Haq; Katherine J Lutz; Kyle K Peters; Kevin A Paternostro; Natalie E Craig; Nathan W L Stencel; Lila F Hawkinson; Maedeh Khayyat-Kholghi; Larisa G Tereshchenko Journal: BMJ Open Date: 2021-09-03 Impact factor: 3.006