Abstract
Ischaemic stroke in young individuals often remains cryptogenic. In this pilot study, we investigated, whether advanced echocardiography methods could find differences in the diastolic function between young cryptogenic stroke patients and stroke-free controls. We recruited 30 cryptogenic ischaemic stroke patients aged 18-49 and 30 age- and sex-matched stroke-free controls among participants of the Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome (SECRETO) study (NCT01934725). We measured diastolic function parameters derived from speckle tracking strain rate, Doppler techniques and 4D volumetry. We also performed statistical analyses comparing only the highest and lowest tertile of cases and controls for each parameter. None of our patients or controls had diastolic dysfunction according to ASE/EACVI criteria. However, compared to stroke-free controls, the stroke patient group had lower E/A ratio of mitral inflow, lower lateral and mean e', lower A/a' ratio, lower strain rate in early diastole and lower speckle tracking-derived e/a ratio. When comparing the lowest tertiles, patients also had a lower peak filling rate by 4D volumetry, a lower peak early filling fraction (fraction of left ventricular filling during early diastole), and lower velocities in a series of the tissue Doppler-derived diastolic parameters and blood flow/tissue velocity ratios. Our study displayed subtle differences in diastolic function between patients and stroke-free controls, which may play a role in early-onset cryptogenic stroke. The differences were clearer when the lowest tertiles were compared, suggesting that there is a subgroup of young cryptogenic stroke patients with subclinical heart disease.
Highlights
Ischaemic stroke can occur due to cardioembolism
In older patients, altered diastolic function is associated with a higher risk of left atrial appendix thrombosis in patients with atrial fibrillation (AF), and diastolic dysfunction is associated with worse outcome after ischaemic stroke (Doukky et al, 2016; Garshick et al, 2018; Park et al, 2016)
Whether advanced echocardiography methods can detect differences in left ventricular diastolic function between young cryptogenic stroke patients and stroke-free controls, and detect whether diastolic function could play a role in cryptogenic stroke in the young
Summary
Ischaemic stroke can occur due to cardioembolism. Some cardiac diseases are categorized as high-risk sources of cardioembolism, due to an over 2% annual ischaemic stroke risk (Ay et al, 2005). Cardiac findings in young (below 50 years) cryptogenic stroke patients have been described very scarcely in the literature. In older patients, altered diastolic function is associated with a higher risk of left atrial appendix thrombosis in patients with atrial fibrillation (AF), and diastolic dysfunction is associated with worse outcome after ischaemic stroke (Doukky et al, 2016; Garshick et al, 2018; Park et al, 2016). Whether advanced echocardiography methods can detect differences in left ventricular diastolic function between young cryptogenic stroke patients and stroke-free controls, and detect whether diastolic function could play a role in cryptogenic stroke in the young. Patients had a higher prevalence of right-to-left shunt. There were no differences between the two groups in basic LV diameter, LV wall thickness or LV ejection fraction
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