Clinical, Imaging, and Atrial Cardiopathy Markers in Ischemic Stroke Subtypes - Clues to a Cardioembolic Source.

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Annals of Indian Academy of Neurology Pub Date : 2025-01-10 DOI:10.4103/aian.aian_772_24

Sapna Erat Sreedharan, Kakarla Saikiran, S C Chandralekha, C A Athira, P N Sylaja, V T Jissa, Narayanan Namboodiri

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引用次数: 0

Abstract

Background and objectives: Cryptogenic strokes account for 20%-25% of all ischemic strokes. Although atrial cardiopathy markers are more prevalent in the cryptogenic embolic stroke of undetermined source (ESUS) subgroup than in the nonembolic stroke subgroup, the utility of individual parameters in predicting cardioembolic sources needs to be studied further. We studied the clinical, imaging, and atrial cardiopathy markers in three ischemic stroke subtypes - large artery atherosclerosis (LAA), cardioembolism (CE), and cryptogenic ESUS - and their role in predicting the source of CE.

Methods: This was a prospective observational study of ischemic stroke patients at Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum from April 2021 to December 2022. Clinical and risk factor profiles, imaging details, atrial cardiopathy marker (N-terminal pro-brain natriuretic peptide [NT-pro-BNP]) levels, electrocardiogram (ECG) parameters (P terminal force of V1 [PTFV1], P wave duration, the PR interval), and transthoracic echo parameters (left atrial [LA] diameter and LA volume) were collected. Associations were made between clinical, imaging, and atrial cardiopathy markers and etiological subtypes.

Results: We had 255 participants (LAA- 98, CE- 41, and ESUS- 139) with a mean age of 63.53 years. Among the atrial cardiopathy markers, the most prevalent was elevated NT-pro-BNP (43.95%), followed by the ECG markers P wave duration (30.92%) and PTFV1 (28.74%), and LA diameter greater than 37 mm (24.27%) and LA volume greater than 34 ml/m2 (20.31%). Among the atrial cardiopathy markers, NT-pro-BNP and LA enlargement were strongly predictive of CE etiology, when compared to LAA. Chronic non-lacunar infarcts on imaging and elevated NT-pro-BNP showed a strong association with CE, when compared to cryptogenic strokes.

Conclusions: The atrial cardiopathy biomarker NT-pro-BNP and chronic non-lacunar infarcts can serve as useful tools for recognizing cardioembolic sources among patients with embolic strokes.

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缺血性脑卒中亚型的临床、影像学和心房心脏病标志物——心脏栓塞来源的线索。

背景和目的：隐源性卒中占所有缺血性卒中的20%-25%。虽然心房心脏病标志物在未确定来源的隐源性栓塞性卒中（ESUS）亚组中比在非栓塞性卒中亚组中更普遍，但个体参数在预测心脏栓塞源中的效用需要进一步研究。我们研究了三种缺血性卒中亚型——大动脉粥样硬化（LAA）、心脏栓塞（CE）和隐源性ESUS的临床、影像学和心房心脏病标志物，以及它们在预测CE来源中的作用。方法：这是一项前瞻性观察研究，研究对象为特里凡得琅Sree Chitra Tirunal医学科学与技术研究所神经内科2021年4月至2022年12月的缺血性卒中患者。收集临床和危险因素概况、影像学细节、心房心脏病标志物（n -末端前脑利钠肽[NT-pro-BNP]）水平、心电图（ECG）参数（V1 P端力[PTFV1]、P波持续时间、PR间期）和经胸回声参数（左心房[LA]直径和LA容积）。临床、影像学和心房心脏病标志物与病因亚型之间存在关联。结果：255名参与者（LAA- 98, CE- 41, ESUS- 139），平均年龄63.53岁。心房病变标志物中以NT-pro-BNP升高最为常见（43.95%），其次是心电图标志物P波持续时间（30.92%）和PTFV1 (28.74%)， LA直径大于37 mm（24.27%）和LA体积大于34 ml/m2（20.31%）。在心房心脏病标志物中，与LAA相比，NT-pro-BNP和LA增大可强烈预测CE病因。与隐源性脑卒中相比，慢性非腔隙性脑梗死和NT-pro-BNP升高显示与CE有很强的相关性。结论：心房心脏病生物标志物NT-pro-BNP和慢性非腔隙性梗死可作为识别栓塞性卒中患者心脏栓塞来源的有用工具。

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来源期刊

Annals of Indian Academy of Neurology Nervous System Diseases-

CiteScore

2.20

自引率

11.80%

发文量

293

审稿时长

29 weeks

期刊介绍： The journal has a clinical foundation and has been utilized most by clinical neurologists for improving the practice of neurology. While the focus is on neurology in India, the journal publishes manuscripts of high value from all parts of the world. Journal publishes reviews of various types, original articles, short communications, interesting images and case reports. The journal respects the scientific submission of its authors and believes in following an expeditious double-blind peer review process and endeavors to complete the review process within scheduled time frame. A significant effort from the author and the journal perhaps enables to strike an equilibrium to meet the professional expectations of the peers in the world of scientific publication. AIAN believes in safeguarding the privacy rights of human subjects. In order to comply with it, the journal instructs all authors when uploading the manuscript to also add the ethical clearance (human/animals)/ informed consent of subject in the manuscript. This applies to the study/case report that involves animal/human subjects/human specimens e.g. extracted tooth part/soft tissue for biopsy/in vitro analysis.