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Intracardiac ECG pulse localization using overlapping block sparse reconstruction. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.103921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Black-white Differences in Left Ventricular Hypertrophy Rates Among Young Adults with Ischemic Stroke. J Stroke Cerebrovasc Dis 2022; 31:106628. [PMID: 35797764 PMCID: PMC9347234 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/02/2022] [Accepted: 06/26/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Few studies have addressed Black-White differences in left ventricular hypertrophy (LVH) in young stroke patients without a history of hypertension. METHODS A case-only cross-sectional analysis performed in 2019 of data from the Stroke Prevention in Young Adults Study, a population-based case-control study of ischemic stroke patients ages 15-49. The main outcomes were hypertension indicators at the time of stroke hospitalization: self-reported history of hypertension, LVH by echocardiography (Echo-LVH) and LVH by electrocardiogram (ECG-LVH). The prevalence of Echo-LVH was further determined in those with and without a history of hypertension. Adjusted odds ratios and 95% confidence intervals comparing blacks and whites were calculated by logistic regression. RESULTS The study population included 1028 early-onset ischemic stroke patients, 48% Black cases, 54% men, median age 43 years (interquartile range, 38-46 years). Overall, the prevalence of hypertension history, Echo-LVH and ECG-LVH were 41.3%, 34.1% and 17.5%, respectively. Each of the hypertension indicators were more frequent in men than in women and in Black cases than in White cases. Black patients without a history of hypertension had higher rates of Echo-LVH than their white counterparts, 40.3% vs 27.7% (age and obesity adjusted OR 1.8; 95% CI 1.02-3.4) among men and 20.9% vs 7.6% (adjusted OR 2.7; 95% CI 1.2-6.2) among women. CONCLUSIONS LVH was common in young patients with ischemic stroke, regardless of self-reported history of hypertension. These findings emphasize the need for earlier screening and more effective treatment of hypertension in young adults, particularly in the Black population.
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Wang Y, Han X, Zhang X, Zhang Z, Cong L, Tang S, Hou T, Liu C, Han X, Zhang Q, Feng J, Yin L, Song L, Dong Y, Liu R, Li Y, Ngandu T, Kivipelto M, Snyder H, Carrillo M, Persson J, Fratiglioni L, Launer LJ, Jia J, Du Y, Qiu C. Health status and risk profiles for brain aging of rural-dwelling older adults: Data from the interdisciplinary baseline assessments in MIND-China. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12254. [PMID: 35441085 PMCID: PMC9009233 DOI: 10.1002/trc2.12254] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 02/01/2023]
Abstract
Introduction Multidomain intervention approaches have emerged as a potential strategy to reduce dementia risk. We sought to describe the baseline assessment approaches, health conditions, and risk profiles for brain aging of participants in the randomized controlled Multimodal INterventions to delay Dementia and disability in rural China (MIND‐China). Methods MIND‐China engaged residents who were ≥60 years of age and living in rural communities in the western Shandong province. In March to September 2018, all participants underwent the core module assessments via face‐to‐face interviews, clinical examinations, neuropsychological testings, and laboratory tests. Specific modules of examination were performed for sub‐samples, including brain magnetic resonance imaging scans, genetic and blood biochemical markers, actigraphy testing, cardiopulmonary coupling analysis for sleep quality and disturbances, audiometric testing, and optical coherence tomography examination. We performed descriptive analysis. Results In total, 5765 participants (74.9% of all eligible residents) undertook the baseline assessments. The mean age was 70.9 years (standard deviation, 5.9), 57.2% were women, 40.6% were illiterate, and 88.3% were farmers. The overall prevalence of common chronic diseases was 67.2% for hypertension, 23.4% for dyslipidemia, 23.5% for heart disease, 14.4% for diabetes mellitus, and 5.4% for dementia. The prevalence rates of hypertension, diabetes mellitus, dyslipidemia, obesity, heart disease, depressive symptoms, and dementia were higher in women than in men (P < .05). Overall, 87.1% of the participants had at least two of the 15 chronic diseases (89.3% in women vs 84.2% in men, P < .001). Participants examined for the specific modules were younger, more likely to be women, and more educated than those not examined. Discussion Comprehensive baseline assessments of participants in MIND‐China provide extremely valuable data sources for interdisciplinary research into the complex relationships of aging, health, brain aging, and functional consequences among older adults living in the rural communities. Highlights MIND‐China is a multimodal intervention study among rural residents ≥60 years of age. At baseline, 5765 participants undertook the interdisciplinary assessments. The baseline assessments consisted of core module and specific modules. Specific modules included brain magnetic resonance imaging (MRI), blood biomarkers, ActiGraph, cardiopulmonary coupling (CPC), pure‐tone audiometry (PTA), and optical coherence tomography (OCT).
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Affiliation(s)
- Yongxiang Wang
- Department of Neurology Shandong Provincial Hospital affiliated to Shandong First Medical University Jinan Shandong China.,Department of Neurology Shandong Provincial Hospital Cheeloo College of Medicine Shandong University Jinan Shandong China.,Shandong Provincial Clinical Research Center for Neurological Diseases Jinan Shandong China
| | - Xiaolei Han
- Department of Neurology Shandong Provincial Hospital Cheeloo College of Medicine Shandong University Jinan Shandong China.,Shandong Provincial Clinical Research Center for Neurological Diseases Jinan Shandong China
| | | | | | - Lin Cong
- Department of Neurology Shandong Provincial Hospital affiliated to Shandong First Medical University Jinan Shandong China.,Department of Neurology Shandong Provincial Hospital Cheeloo College of Medicine Shandong University Jinan Shandong China.,Shandong Provincial Clinical Research Center for Neurological Diseases Jinan Shandong China
| | - Shi Tang
- Department of Neurology Shandong Provincial Hospital affiliated to Shandong First Medical University Jinan Shandong China.,Department of Neurology Shandong Provincial Hospital Cheeloo College of Medicine Shandong University Jinan Shandong China.,Shandong Provincial Clinical Research Center for Neurological Diseases Jinan Shandong China
| | - Tingting Hou
- Department of Neurology Shandong Provincial Hospital affiliated to Shandong First Medical University Jinan Shandong China.,Department of Neurology Shandong Provincial Hospital Cheeloo College of Medicine Shandong University Jinan Shandong China.,Shandong Provincial Clinical Research Center for Neurological Diseases Jinan Shandong China
| | - Cuicui Liu
- Department of Neurology Shandong Provincial Hospital affiliated to Shandong First Medical University Jinan Shandong China.,Department of Neurology Shandong Provincial Hospital Cheeloo College of Medicine Shandong University Jinan Shandong China.,Shandong Provincial Clinical Research Center for Neurological Diseases Jinan Shandong China
| | - Xiaojuan Han
- Department of Neurology Shandong Provincial Hospital affiliated to Shandong First Medical University Jinan Shandong China.,Department of Neurology Shandong Provincial Hospital Cheeloo College of Medicine Shandong University Jinan Shandong China.,Shandong Provincial Clinical Research Center for Neurological Diseases Jinan Shandong China
| | - Qinghua Zhang
- Department of Neurology Shandong Provincial Hospital affiliated to Shandong First Medical University Jinan Shandong China.,Department of Neurology Shandong Provincial Hospital Cheeloo College of Medicine Shandong University Jinan Shandong China.,Shandong Provincial Clinical Research Center for Neurological Diseases Jinan Shandong China
| | - Jianli Feng
- Department of Neurology Shandong Second Provincial General Hospital Shandong Provincial ENT Hospital Jinan Shandong China
| | - Ling Yin
- Department of Neurology Shandong Provincial Hospital affiliated to Shandong First Medical University Jinan Shandong China.,Department of Neurology Shandong Provincial Hospital Cheeloo College of Medicine Shandong University Jinan Shandong China.,Shandong Provincial Clinical Research Center for Neurological Diseases Jinan Shandong China
| | - Lin Song
- Department of Neurology Shandong Provincial Hospital affiliated to Shandong First Medical University Jinan Shandong China.,Department of Neurology Shandong Provincial Hospital Cheeloo College of Medicine Shandong University Jinan Shandong China.,Shandong Provincial Clinical Research Center for Neurological Diseases Jinan Shandong China
| | - Yi Dong
- Department of Neurology Shandong Provincial Hospital Cheeloo College of Medicine Shandong University Jinan Shandong China.,Shandong Provincial Clinical Research Center for Neurological Diseases Jinan Shandong China
| | - Rui Liu
- Department of Neurology Shandong Provincial Hospital Cheeloo College of Medicine Shandong University Jinan Shandong China.,Shandong Provincial Clinical Research Center for Neurological Diseases Jinan Shandong China
| | - Yuanjing Li
- Department of Neurology Shandong Provincial Hospital Cheeloo College of Medicine Shandong University Jinan Shandong China.,Shandong Provincial Clinical Research Center for Neurological Diseases Jinan Shandong China
| | - Tiia Ngandu
- Division of Clinical Geriatrics and Center for Alzheimer Research Department of Neurobiology Care Sciences and Society (NVS) Karolinska Institutet Stockholm Sweden.,Department of Public Health and Welfare Finnish Institute for Health and Welfare Finland
| | - Miia Kivipelto
- Division of Clinical Geriatrics and Center for Alzheimer Research Department of Neurobiology Care Sciences and Society (NVS) Karolinska Institutet Stockholm Sweden
| | | | | | - Jonas Persson
- Aging Research Center Department of NVS Karolinska Institutet and Stockholm University Stockholm Sweden
| | - Laura Fratiglioni
- Aging Research Center Department of NVS Karolinska Institutet and Stockholm University Stockholm Sweden
| | - Lenore J Launer
- Intramural Research Program Laboratory of Epidemiology and Population Sciences National Institute on Aging National Institutes of Health Baltimore Maryland USA
| | - Jianping Jia
- Innovation Center for Neurological Disorders Department of Neurology Xuanwu Hospital Capital Medical University Beijing China
| | - Yifeng Du
- Department of Neurology Shandong Provincial Hospital affiliated to Shandong First Medical University Jinan Shandong China.,Department of Neurology Shandong Provincial Hospital Cheeloo College of Medicine Shandong University Jinan Shandong China.,Shandong Provincial Clinical Research Center for Neurological Diseases Jinan Shandong China
| | - Chengxuan Qiu
- Department of Neurology Shandong Provincial Hospital Cheeloo College of Medicine Shandong University Jinan Shandong China.,Aging Research Center Department of NVS Karolinska Institutet and Stockholm University Stockholm Sweden
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Markus A, Valerie S, Mira K. Promising Biomarker Candidates for Cardioembolic Stroke Etiology. A Brief Narrative Review and Current Opinion. Front Neurol 2021; 12:624930. [PMID: 33716927 PMCID: PMC7947187 DOI: 10.3389/fneur.2021.624930] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/11/2021] [Indexed: 01/09/2023] Open
Abstract
Determining the cause of stroke is considered one of the main objectives in evaluating a stroke patient in clinical practice. However, ischemic stroke is a heterogeneous disorder and numerous underlying disorders are implicated in its pathogenesis. Although progress has been made in identifying individual stroke etiology, in many cases underlying mechanisms still remain elusive. Since secondary prevention strategies are tailored toward individual stroke mechanisms, patients whose stroke etiology is unknown may not receive optimal preventive treatment. Cardioembolic stroke is commonly defined as cerebral vessel occlusion by distant embolization arising from thrombus formation in the heart. It accounts for the main proportion of ischemic strokes, and its share to stroke etiology is likely to rise even further in future decades. However, it can be challenging to distinguish cardioembolism from other possible etiologies. As personalized medicine advances, stroke researchers' focus is increasingly drawn to etiology-associated biomarkers. They can provide deeper insight regarding specific stroke mechanisms and can help to unravel previously undetected pathologies. Furthermore, etiology-associated biomarkers could play an important role in guiding future stroke prevention strategies. To achieve this, broad validation of promising candidate biomarkers as well as their implementation in well-designed randomized clinical trials is necessary. This review focuses on the most-promising candidates for diagnosis of cardioembolic stroke. It discusses existing evidence for possible clinical applications of these biomarkers, addresses current challenges, and outlines future perspectives.
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Affiliation(s)
- Arnold Markus
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
| | - Schütz Valerie
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
| | - Katan Mira
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
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Johansen MC, Doria de Vasconcellos H, Nazarian S, Lima JAC, Gottesman RF. The Investigation of Left Atrial Structure and Stroke Etiology: The I-LASER Study. J Am Heart Assoc 2021; 10:e018766. [PMID: 33442991 PMCID: PMC7955322 DOI: 10.1161/jaha.120.018766] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Left atrial (LA) function is important in stroke, but often poorly characterized. We evaluated the association of 2-dimensional speckle tracking echocardiography LA variables with stroke subtype (cardioembolic stroke [CS] or cryptogenic stroke versus other). The hypothesis is worse LA active function is associated with CS, but not cryptogenic strokes. Methods and Results In this prospective cohort (2017-2019), left ventricular/LA structure and function were quantified by 2-dimensional and speckle tracking echocardiography in 151 patients with stroke. Strain/strain rate curves for the 3 components of the LA cycle, ie, (1) Reservoir (global longitudinal strain [Srmax]), (2) Conductive (early LA Sr [Sre]), and (3) Active (late LA strain [Sra]) were evaluated, masked to stroke subtype. Associations of cardiac features with stroke subtype were tested using multivariable logistic regressions. Odds of CS were increased in patients with a larger LA systolic diameter (odds ratio [OR], 2.96, 95% CI, 1.14-7.69) but reduced in patients with a higher Srmax (better reservoir) (OR, 0.80, 95% CI, 0.67-0.97). Lower Sra (worse function) was associated with an increased odds of CS (OR, 1.72, 95% CI, 1.07-2.76) but not independent of atrial fibrillation. Higher active LA emptying fraction (better active phase) was associated with reduced odds of CS (OR, 0.74, 95% CI, 0.57-0.95) or cryptogenic stroke (OR, 0.82, 95% CI, 0.68-0.98) versus other subtypes; other associations between cryptogenic stroke and speckle tracking echocardiography were not found. Conclusions Markers of LA structure and function were associated with CS. Similar associations were not found for cryptogenic stroke, which might suggest different underlying mechanisms, given study limitations. Further understanding could aid stroke diagnosis and secondary stroke prevention research.
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Affiliation(s)
- Michelle C Johansen
- Department of Neurology The Johns Hopkins University School of Medicine Baltimore MD
| | | | - Saman Nazarian
- Department of Cardiology The University of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Joao A C Lima
- Department of Cardiology The Johns Hopkins University School of Medicine Baltimore MD
| | - Rebecca F Gottesman
- Department of Neurology The Johns Hopkins University School of Medicine Baltimore MD
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Blinova EV, Sakhnova TA, Yurasova ES. [Diagnostic and prognostic significance of QRS-T angle]. TERAPEVT ARKH 2020; 92:85-93. [PMID: 33346436 DOI: 10.26442/00403660.2020.09.000752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 12/28/2022]
Abstract
The angle between theQRSandTvectors reflects the consistency or inconsistency of the processes of de- and repolarization of the ventricles of the heart and is considered one of the indicators of global electrical heterogeneity of myocardium. In recent years, the prognostic value of theQRS-Tangle has been demonstrated in relation to total and cardiovascular mortality, both in the population and in various groups of patients. The mechanisms of this phenomenon are not completely clear. The review analyses studies published over the past five years on the relationship between theQRS-Tangle and mortality, as well as coronary heart disease and heart failure. Possible mechanisms for increasing theQRS-Tangle are discussed. Data are given on the use of theQRS-Tangle in diagnostic and prognostic scales, including in combination with other indicators of global electrical heterogeneity of myocardium.
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Affiliation(s)
- E V Blinova
- National Medical Research Center for Cardiology
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Prasitlumkum N, Cheungpasitporn W, Mekritthikrai R, Thongprayoon C, Bathini T, Vallabhajosyula S, Chokesuwattanaskul R. Interatrial block and its association with an increased risk of ischemic stroke: A systematic review and meta-analysis. J Electrocardiol 2020; 61:92-98. [PMID: 32554163 DOI: 10.1016/j.jelectrocard.2020.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/30/2020] [Accepted: 06/08/2020] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Several studies have suggested the association between interatrial block (IAB) and ischemic stroke. As no prior collective study has been discerned in this issue, we hence conducted systemic review and meta-analysis to assess the relationship between IAB and ischemic stroke. METHODS We comprehensively searched the databases of MEDLINE, EMBASE, PUBMED, and the Cochrane from inception to January 2020. Included studies were published observational studies that compared the risk of ischemic stroke among patients with and without IAB. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals (CIs). Subgroup analyses and meta-regression were performed to explore heterogeneity. RESULTS Ten studies were included in this analysis, involving total 177,249 participants. Our study demonstrated no association between partial IAB and an increased risk of ischemic stroke with OR 1.19 (95% CI 0.99-1.43 p = 0.054),but a statistical correlation with an increased risk of stroke with OR 1.85 (95% CI 1.37-2.50, p < 0.001) in advanced IAB. Interestingly, our subgroup analysis of patients with prior stroke suggested higher risk of recurrent stroke in both advanced IAB (OR 4.73) and partial IAB (OR 1.65). Meta-regression suggested a history of stroke as an effect modifier in the interplay between IAB and risk of recurrent stroke. CONCLUSION Only advanced IAB is associated with an increased risk of stroke. However, further studies are warranted to further support this finding to confirm its clinical feasibility in stroke risk stratification.
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Affiliation(s)
| | - Wisit Cheungpasitporn
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | | | | | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ, USA
| | | | - Ronpichai Chokesuwattanaskul
- Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand; Division of Cardiac Electrophysiology, University of Michigan Health Care, Ann Arbor, MI, USA
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Epidemiology, aetiology, and management of ischaemic stroke in young adults. Lancet Neurol 2019; 17:790-801. [PMID: 30129475 DOI: 10.1016/s1474-4422(18)30233-3] [Citation(s) in RCA: 214] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 06/01/2018] [Accepted: 06/05/2018] [Indexed: 01/15/2023]
Abstract
Epidemiological evidence suggests that the incidence of ischaemic stroke in young adults (18-50 years) has increased substantially. These patients have a long life expectancy after stroke, and the costs of long-term care pose huge challenges to health-care systems. Although the current recommendations for treatment of young and old (>50 years) patients with stroke are similar, the optimal management of young adult patients with stroke is unknown. They are usually not included in trials, and specific subanalyses limited to young adult patients with stroke are usually not done, owing to lower incidence of stroke and lower prevalence of vascular risk factors in young adults. Progress has been made in identifying patients with a considerable risk of stroke occurrence, such as those with patent foramen ovale. Future prevention studies might result in a decrease in the incidence of stroke and its sequelae in young adults. The development of guidelines specifically devoted to the management of stroke in young adults will be an important step in achieving this aim.
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Seoane L, Cortés M, Conde D. Update on Bayés' syndrome: the association between an interatrial block and supraventricular arrhythmias. Expert Rev Cardiovasc Ther 2019; 17:225-235. [PMID: 30715961 DOI: 10.1080/14779072.2019.1577137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The past few years have given rise to extensive research on an interatrial block and its clinical relevance, mainly its association with supraventricular arrhythmias. In 2015, the authors of this article reviewed the Bayes syndrome for the first time and after three years there has been so much evidence accumulated that it seems reasonable to rewrite an update, based fundamentally on the new findings. Focused on its relationship with cardioembolic strokes, today efforts are being targeted at understanding its pathophysiology, its diagnosis, and its prognostic implications, in order to learn if it should be treated. Areas covered: A non-systematic review of the literature was developed using the Pubmed and Cochrane databases, focusing on randomized clinical trials and large observational studies that evaluated new physiopathological and epidemiological aspects, new clinical scenarios in which it has been assessed and its association with dementia. Finally, those studies that proposed new possible treatments were reviewed. Expert commentary: Interatrial block is not only a predictor of supraventricular arrhythmias, is a subclinical disease that might be considered as a marker of risk for adverse outcomes. Although there is some evidence to suggest that early treatment may be beneficial, potential therapies have yet to be investigated.
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Affiliation(s)
- Leonardo Seoane
- a Department of Cardiology , Instituto Cardiovascular de Buenos Aires , Buenos Aires , Argentina
| | - Marcia Cortés
- a Department of Cardiology , Instituto Cardiovascular de Buenos Aires , Buenos Aires , Argentina
| | - Diego Conde
- a Department of Cardiology , Instituto Cardiovascular de Buenos Aires , Buenos Aires , Argentina
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Pirinen J, Eranti A, Knekt P, Lehto M, Martinez-Majander N, Aro AL, Rissanen H, Heliövaara M, Kaste M, Tatlisumak T, Huikuri H, Putaala J. ECG markers associated with ischemic stroke at young age - a case-control study. Ann Med 2017; 49:562-568. [PMID: 28657357 DOI: 10.1080/07853890.2017.1348620] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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.
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Affiliation(s)
- Jani Pirinen
- a Department of Cardiology , Heart and Lung Center, Helsinki University Hospital, University of Helsinki , Helsinki , Finland.,b Department of Neurology, Clinical Neurosciences , Helsinki University Hospital, University of Helsinki , Helsinki , Finland.,c Department of Clinical Physiology and Nuclear Medicine , HUS Medical Imaging Center, Helsinki University Hospital, University of Helsinki , Helsinki , Finland
| | - Antti Eranti
- d Department of Internal Medicine , Päijät-Häme Central Hospital , Lahti , Finland
| | - Paul Knekt
- e Department of Health, Functional Capacity, and Welfare , National Institute for Health and Welfare (Terveyden ja Hyvinvoinnin Laitos) , Helsinki , Finland
| | - Mika Lehto
- a Department of Cardiology , Heart and Lung Center, Helsinki University Hospital, University of Helsinki , Helsinki , Finland
| | - Nicolas Martinez-Majander
- b Department of Neurology, Clinical Neurosciences , Helsinki University Hospital, University of Helsinki , Helsinki , Finland
| | - Aapo L Aro
- a Department of Cardiology , Heart and Lung Center, Helsinki University Hospital, University of Helsinki , Helsinki , Finland
| | - Harri Rissanen
- e Department of Health, Functional Capacity, and Welfare , National Institute for Health and Welfare (Terveyden ja Hyvinvoinnin Laitos) , Helsinki , Finland
| | - Markku Heliövaara
- e Department of Health, Functional Capacity, and Welfare , National Institute for Health and Welfare (Terveyden ja Hyvinvoinnin Laitos) , Helsinki , Finland
| | - Markku Kaste
- b Department of Neurology, Clinical Neurosciences , Helsinki University Hospital, University of Helsinki , Helsinki , Finland
| | - Turgut Tatlisumak
- b Department of Neurology, Clinical Neurosciences , Helsinki University Hospital, University of Helsinki , Helsinki , Finland.,f Department of Clinical Neurosciences/Neurology , Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Heikki Huikuri
- g Medical Research Center Oulu , Oulu University Hospital, University of Oulu , Oulu , Finland
| | - Jukka Putaala
- b Department of Neurology, Clinical Neurosciences , Helsinki University Hospital, University of Helsinki , Helsinki , Finland
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He J, Tse G, Korantzopoulos P, Letsas KP, Ali-Hasan-Al-Saegh S, Kamel H, Li G, Lip GYH, Liu T. P-Wave Indices and Risk of Ischemic Stroke: A Systematic Review and Meta-Analysis. Stroke 2017; 48:2066-2072. [PMID: 28679858 DOI: 10.1161/strokeaha.117.017293] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/26/2017] [Accepted: 05/23/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Atrial cardiomyopathy is associated with an increased risk of ischemic stroke. P-wave terminal force in lead V1, P-wave duration, and maximum P-wave area are electrocardiographic parameters that have been used to assess left atrial abnormalities related to developing atrial fibrillation. The aim of this systematic review and meta-analysis was to examine their values for predicting ischemic stroke risk. METHODS PubMed and EMBASE databases were searched until December 2016 for studies that evaluated the association between P-wave indices and stroke risk. Both fixed- and random-effects models were used to calculate the overall effect estimates. RESULTS Ten studies examining P-wave terminal force in lead V1, P-wave duration, and maximum P-wave area were included. P-wave terminal force in lead V1 was found to be an independent predictor of stroke as both a continuous variable (odds ratio [OR] per 1 SD change, 1.18; 95% confidence interval [CI], 1.12-1.25; P<0.0001) and categorical variable (OR, 1.59; 95% CI, 1.10-2.28; P=0.01). P-wave duration was a significant predictor of incident ischemic stroke when analyzed as a categorical variable (OR, 1.86; 95% CI, 1.37-2.52; P<0.0001) but not when analyzed as a continuous variable (OR, 1.05; 95% CI, 0.98-1.13; P=0.15). Maximum P-wave area also predicted the risk of incident ischemic stroke (OR per 1 SD change, 1.10; 95% CI, 1.04-1.17). CONCLUSIONS P-wave terminal force in lead V1, P-wave duration, and maximum P-wave area are useful electrocardiographic markers that can be used to stratify the risk of incident ischemic stroke.
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Affiliation(s)
- Jinli He
- From the Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People's Republic of China (J.H., G.L., T.L.); Department of Medicine and Therapeutics (G.T.) and Li Ka Shing Institute of Health Science (G.T.), Chinese University of Hong Kong, SAR, People's Republic of China; First Department of Cardiology, University Hospital of Ioannina, Greece (P.K.); Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece (K.P.L.); Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran (S.A.-H.-A.-S.); Weill Cornell Medical College, New York, NY (H.K.); Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom (G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
| | - Gary Tse
- From the Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People's Republic of China (J.H., G.L., T.L.); Department of Medicine and Therapeutics (G.T.) and Li Ka Shing Institute of Health Science (G.T.), Chinese University of Hong Kong, SAR, People's Republic of China; First Department of Cardiology, University Hospital of Ioannina, Greece (P.K.); Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece (K.P.L.); Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran (S.A.-H.-A.-S.); Weill Cornell Medical College, New York, NY (H.K.); Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom (G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.).
| | - Panagiotis Korantzopoulos
- From the Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People's Republic of China (J.H., G.L., T.L.); Department of Medicine and Therapeutics (G.T.) and Li Ka Shing Institute of Health Science (G.T.), Chinese University of Hong Kong, SAR, People's Republic of China; First Department of Cardiology, University Hospital of Ioannina, Greece (P.K.); Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece (K.P.L.); Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran (S.A.-H.-A.-S.); Weill Cornell Medical College, New York, NY (H.K.); Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom (G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
| | - Konstantinos P Letsas
- From the Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People's Republic of China (J.H., G.L., T.L.); Department of Medicine and Therapeutics (G.T.) and Li Ka Shing Institute of Health Science (G.T.), Chinese University of Hong Kong, SAR, People's Republic of China; First Department of Cardiology, University Hospital of Ioannina, Greece (P.K.); Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece (K.P.L.); Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran (S.A.-H.-A.-S.); Weill Cornell Medical College, New York, NY (H.K.); Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom (G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
| | - Sadeq Ali-Hasan-Al-Saegh
- From the Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People's Republic of China (J.H., G.L., T.L.); Department of Medicine and Therapeutics (G.T.) and Li Ka Shing Institute of Health Science (G.T.), Chinese University of Hong Kong, SAR, People's Republic of China; First Department of Cardiology, University Hospital of Ioannina, Greece (P.K.); Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece (K.P.L.); Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran (S.A.-H.-A.-S.); Weill Cornell Medical College, New York, NY (H.K.); Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom (G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
| | - Hooman Kamel
- From the Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People's Republic of China (J.H., G.L., T.L.); Department of Medicine and Therapeutics (G.T.) and Li Ka Shing Institute of Health Science (G.T.), Chinese University of Hong Kong, SAR, People's Republic of China; First Department of Cardiology, University Hospital of Ioannina, Greece (P.K.); Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece (K.P.L.); Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran (S.A.-H.-A.-S.); Weill Cornell Medical College, New York, NY (H.K.); Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom (G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
| | - Guangping Li
- From the Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People's Republic of China (J.H., G.L., T.L.); Department of Medicine and Therapeutics (G.T.) and Li Ka Shing Institute of Health Science (G.T.), Chinese University of Hong Kong, SAR, People's Republic of China; First Department of Cardiology, University Hospital of Ioannina, Greece (P.K.); Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece (K.P.L.); Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran (S.A.-H.-A.-S.); Weill Cornell Medical College, New York, NY (H.K.); Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom (G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
| | - Gregory Y H Lip
- From the Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People's Republic of China (J.H., G.L., T.L.); Department of Medicine and Therapeutics (G.T.) and Li Ka Shing Institute of Health Science (G.T.), Chinese University of Hong Kong, SAR, People's Republic of China; First Department of Cardiology, University Hospital of Ioannina, Greece (P.K.); Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece (K.P.L.); Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran (S.A.-H.-A.-S.); Weill Cornell Medical College, New York, NY (H.K.); Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom (G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
| | - Tong Liu
- From the Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People's Republic of China (J.H., G.L., T.L.); Department of Medicine and Therapeutics (G.T.) and Li Ka Shing Institute of Health Science (G.T.), Chinese University of Hong Kong, SAR, People's Republic of China; First Department of Cardiology, University Hospital of Ioannina, Greece (P.K.); Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece (K.P.L.); Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran (S.A.-H.-A.-S.); Weill Cornell Medical College, New York, NY (H.K.); Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom (G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
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Arboix A, Martí L, Dorison S, Sánchez MJ. Bayés syndrome and acute cardioembolic ischemic stroke. World J Clin Cases 2017; 5:93-101. [PMID: 28352633 PMCID: PMC5352964 DOI: 10.12998/wjcc.v5.i3.93] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/10/2016] [Accepted: 12/09/2016] [Indexed: 02/05/2023] Open
Abstract
Bayés syndrome is an under-recognized clinical condition characterized by advanced interatrial block. Bayés syndrome is a subclinical disease that manifests electrocardiographically as a prolonged P wave duration > 120 ms with biphasic morphology ± in the inferior leads. The clinical relevance of Bayés syndrome lies in the fact that is a clear arrhythmological syndrome and has a strong association with supraventricular arrhythmias, particularly atypical atrial flutter and atrial fibrillation. Likewise, Bayés syndrome has been recently identified as a novel risk factor for non-lacunar cardioembolic ischemic stroke and vascular dementia. Advanced interatrial block can be a risk for embolic stroke due to its known sequelae of left atrial dilation, left atrial electromechanical dysfunction or atrial tachyarrhythmia (paroxysmal or persistent atrial fibrillation), conditions predisposing to thromboembolism. Bayés syndrome may be responsible for some of the unexplained ischemic strokes and shall be considered and investigated as a possible cause for cryptogenetic stroke. In summary, Bayés syndrome is a poorly recognized cardiac rhythm disorder with important cardiologic and neurologic implications.
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Pirinen J, Putaala J, Aarnio K, Aro AL, Mustanoja S, Sinisalo J, Kaste M, Haapaniemi E, Tatlisumak T, Lehto M. Twelve-lead electrocardiogram and mortality in young adults after ischaemic stroke. Eur Stroke J 2017; 2:77-86. [PMID: 31008304 DOI: 10.1177/2396987316684706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 11/27/2016] [Indexed: 11/15/2022] Open
Abstract
Introduction Ischaemic stroke at young age carries an increased risk for mortality in comparison to the general population, but factors associated with mortality have been poorly studied. We studied the role of electrocardiogram in mortality risk stratification in young stroke patients. Patients and methods The Helsinki Young Stroke Registry encompasses 1008 patients aged <50 years with ischaemic stroke. We included 690 patients for this electrocardiogram substudy. Our endpoints were all-cause and cardiovascular mortality. Cox regression models - adjusted for clinical and demographic characteristics - were used to identify the electrocardiogram parameters associated with these endpoints. Results At a mean follow-up of 8.8 years, cumulative all-cause and cardiovascular mortality were 16.1 and 9.1%, respectively. Factors associated with both endpoints included diabetes (type 1 for all-cause, type 2 for cardiovascular mortality), heavy drinking, malignancy, as well as stroke severity and aetiology. Of the electrocardiogram parameters, higher heart rate (hazard ratio 1.35 per 10/min, 95% confidence interval 1.21-1.49), a shorter P-wave (hazard ratio 0.78 per 10 ms decrement, 0.64-0.92) and longer QTc interval (1.09 per 10 ms, 1.03-1.16) were associated with increased all-cause mortality. Only a higher heart rate (1.42 per 10/min, 1.24-1.60) was associated with death from cardiovascular causes. Conclusions A higher heart rate during the subacute phase after stroke is associated with an elevated risk of all-cause and cardiovascular mortality in young adults. A longer QTc interval is associated only with higher all-cause mortality. P-wave characteristics and their possible association with mortality need further studies.
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Affiliation(s)
- Jani Pirinen
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.,Clinical Neurosciences, Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital, Helsinki, Finland.,Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jukka Putaala
- Clinical Neurosciences, Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Karoliina Aarnio
- Clinical Neurosciences, Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Aapo L Aro
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Satu Mustanoja
- Clinical Neurosciences, Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Juha Sinisalo
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Markku Kaste
- Clinical Neurosciences, Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Elena Haapaniemi
- Clinical Neurosciences, Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Turgut Tatlisumak
- Clinical Neurosciences, Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital, Helsinki, Finland.,Department of Neurology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mika Lehto
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
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Pirinen J, Putaala J, Aarnio K, Aro AL, Sinisalo J, Kaste M, Haapaniemi E, Tatlisumak T, Lehto M. Are 12-lead ECG findings associated with the risk of cardiovascular events after ischemic stroke in young adults? Ann Med 2016; 48:532-540. [PMID: 27684300 DOI: 10.1080/07853890.2016.1202443] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Ischemic stroke (IS) in a young patient is a disaster and recurrent cardiovascular events could add further impairment. Identifying patients with high risk of such events is therefore important. The prognostic relevance of ECG for this population is unknown. MATERIALS AND METHODS A total of 690 IS patients aged 15-49 years were included. A 12-lead ECG was obtained 1-14 d after the onset of stroke. We adjusted for demographic factors, comorbidities, and stroke characteristics, Cox regression models were used to identify independent ECG parameters associated with long-term risks of (1) any cardiovascular event, (2) cardiac events, and (3) recurrent stroke. RESULTS Median follow-up time was 8.8 years. About 26.4% of patients experienced a cardiovascular event, 14.5% had cardiac events, and 14.6% recurrent strokes. ECG parameters associated with recurrent cardiovascular events were bundle branch blocks, P-terminal force, left ventricular hypertrophy, and a broader QRS complex. Furthermore, more leftward P-wave axis, prolonged QTc, and P-wave duration >120 ms were associated with increased risks of cardiac events. No ECG parameters were independently associated with recurrent stroke. CONCLUSION A 12-lead ECG can be used for risk prediction of cardiovascular events but not for recurrent stroke in young IS patients. KEY MESSAGES ECG is an easy, inexpensive, and useful tool for identifying young ischemic stroke patients with a high risk for recurrent cardiovascular events and it has a statistically significant association with these events even after adjusting for confounding factors. Bundle branch blocks, P-terminal force, broader QRS complex, LVH according to Cornell voltage duration criteria, more leftward P-wave axis, prolonged QTc, and P-wave duration >120 ms are predictors for future cardiovascular or cardiac events in these patients. No ECG parameters were independently associated with recurrent stroke.
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Affiliation(s)
- Jani Pirinen
- a Department of Cardiology , Heart and Lung Center, Helsinki University Hospital , Helsinki , Finland.,b Clinical Neurosciences, Department of Neurology, University of Helsinki and Department of Neurology , Helsinki University Hospital , Helsinki , Finland.,c Department of Clinical Physiology and Nuclear Medicine , HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki , Helsinki , Finland
| | - Jukka Putaala
- b Clinical Neurosciences, Department of Neurology, University of Helsinki and Department of Neurology , Helsinki University Hospital , Helsinki , Finland
| | - Karoliina Aarnio
- b Clinical Neurosciences, Department of Neurology, University of Helsinki and Department of Neurology , Helsinki University Hospital , Helsinki , Finland
| | - Aapo L Aro
- a Department of Cardiology , Heart and Lung Center, Helsinki University Hospital , Helsinki , Finland
| | - Juha Sinisalo
- a Department of Cardiology , Heart and Lung Center, Helsinki University Hospital , Helsinki , Finland
| | - Markku Kaste
- b Clinical Neurosciences, Department of Neurology, University of Helsinki and Department of Neurology , Helsinki University Hospital , Helsinki , Finland
| | - Elena Haapaniemi
- b Clinical Neurosciences, Department of Neurology, University of Helsinki and Department of Neurology , Helsinki University Hospital , Helsinki , Finland
| | - Turgut Tatlisumak
- b Clinical Neurosciences, Department of Neurology, University of Helsinki and Department of Neurology , Helsinki University Hospital , Helsinki , Finland.,d Department of Neurology, Institute of Neuroscience and Physiology , Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Mika Lehto
- a Department of Cardiology , Heart and Lung Center, Helsinki University Hospital , Helsinki , Finland
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15
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Akoum N. New perspectives on atrial fibrillation and stroke. Heart 2016; 102:1788-1792. [DOI: 10.1136/heartjnl-2015-309066] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/28/2016] [Accepted: 07/21/2016] [Indexed: 01/08/2023] Open
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Pirinen J, Putaala J, Lehto M. Details on methods and further thoughts on P-wave indices in stroke: Response to the letter "Importance of P-wave indices in stroke", by Chhabra L, regarding "Resting 12-lead electrocardiogram reveals high-risk sources of cardioembolism in young adult ischemic stroke". Int J Cardiol 2016; 216:66-7. [PMID: 27149237 DOI: 10.1016/j.ijcard.2016.04.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 04/10/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Jani Pirinen
- Department of Cardiology, Helsinki University Hospital, Finland; Department of Neurology, Helsinki University Hospital, Finland
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, Finland
| | - Mika Lehto
- Department of Cardiology, Helsinki University Hospital, Finland
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Affiliation(s)
- Lovely Chhabra
- Dept. of Cardiovascular Medicine, Hartford Hospital, University of Connecticut School of Medicine, Hartford, CT 06102, USA.
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