Abstract T P158: Prolonged Atrial Electrical Mechanical Delay on Echocardiography in Patients With Cryptogenic Stroke

Abstract

Backgrounds and Purpose: One quarter of strokes are cryptogenic, and subclinical atrial fibrillation may be a common etiologic factor. Prolonged atrial electrical-mechanical delay was known as a predictor of paroxysmal atrial fibrillation (AF). We evaluated whether the prevalence of prolonged atrial electrical-mechanical delay suggesting the presence of atrial substrates for paroxysmal AF may be higher in patients with cryptogenic stroke. Methods: We retrospectively reviewed data from patients with ischemic stroke who were admitted to our hospital between January 2011 and December 2012, and selected patients with cryptogenic stroke who underwent echocardiography. Patients who underwent echocardiography for health care examination were enrolled in control group. Age, sex and underlying risk factors were matched in two groups. Atrial electrical-mechanical delay (PA interval) was defined as the time interval (msec) from the initiation of P wave on surface electrocardiogram to the initiation of trans-mitral inflow on pulse wave Doppler echocardiogram during late diastole. Clinical significance of PA interval was evaluated. Results: Total 130 patients in cryptogenic stroke group and 130 persons in control group were enrolled. Mean age was 63 ± 11 years and 176 (68%) were male. The PR interval (178 ± 27 vs. 165 ± 27 msec, p < 0.0001) and PA interval (74 ± 15 vs. 61 ± 13 msec, p < 0.0001) were longer in cryptogenic stroke patients. The body mass index (23 ± 3 vs. 24 ± 3, p = 0.043) was lower and mitral E/E’ ratio (8.8 ± 3.0 vs. 8.0 ± 2.6 msec, p < 0.0001) was higher in cryptogenic stroke group. Prolonged PR (OR: 1.019, CI: 1.009 - 1.029, p < 0.0001) and PA (OR: 1.068, CI: 1.045 - 1.093, p < 0.0001) intervals, and lower body mass index (OR: 0.919, CI: 0.846 - 0.998) were risk factors for cryptogenic stroke in univariate logistic regression analysis. Prolonged PA (OR: 1.060, CI: 1.035 - 1.086, p < 0.0001) and PR (OR: 1.019, CI: 1.004 - 1.034, p = 0.011) intervals, and lower body mass index (OR: 0.845, CI: 0.764 - 0.935, p = 0.001) were risk factors for cryptogenic stroke in multivariate logistic regression analysis. Conclusion: The prevalence of prolonged atrial electrical-mechanical delay suggesting atrial substrates for paroxysmal AF was higher in patients with cryptogenic stroke.