Abstract WP267: Lower Left Ventricular Longitudinal Contraction is Associated With Early-onset Cryptogenic Ischemic Stroke

Abstract

Introduction: At least one third of ischemic strokes at a young age (<50 years) remain cryptogenic after complete diagnostic work-up. We hypothesized that based on their neuroimaging presentation majority of these strokes may originate from the heart and that advanced cardiac ultrasound imaging might reveal hints from underlying left ventricular pathology. Methods: We prospectively recruited 26 patients aged 18-49 with cryptogenic ischemic stroke and 26 age- and sex-matched stroke-free controls. We examined all participants with transthoracic echocardiography and analyzed the left ventricular (LV) ejection fraction (LVEF) with 3-dimensional volumetry. We used speckle-tracking imaging in three planes (apical 4-chamber, 3-chamber and 2-chamber views), to determine LV global longitudinal strain (GLS), and only patients with visibility allowing analysis of all 18 LV segments were included. Tissue Doppler velocity imaging was used to determine the mitral annular plane systolic excursion (MAPSE), as a mean of six annular points in the 3 apical planes. Measurements were normally distributed and group-level differences were analyzed by paired-samples T-tests. Results: A total of 26 pairs had adequate visibility to examine LVEF, 20 to assess GLS, and 25 to examine MAPSE. There was no significant difference in LV ejection fraction between patients and controls (mean 59.0 vs 61.4 (%); P=0.300). LV global longitudinal strain was significantly lower in patients compared with controls (mean 18.0 vs 19.9 (%); P=0.012). Furthermore, MAPSE was lower in patients (mean 13.3 vs 14.2(mm); P=0.044). Conclusion: Young patients with cryptogenic ischemic stroke had lower longitudinal LV contraction than stroke-free individuals of the same age—without differences in LVEF—suggesting that subclinical LV systolic dysfunction may play a role in cryptogenic strokes.