Extrasystolic arrhythmia: is it an additional risk factor of cryptogenic stroke?

Abstract

Aim to study the development of ischemic stroke (IS) or transient ischemic attack (TIA) in patients with extrasystoles (ES), depending on the moment of ES ventricular systole occurrence in cardiocycle.
 Material and methods. The study group included 440 patients with ES 700 per day; the control group consisted of 88 patients with ES 700 per day. The following instrumental and laboratory methods were used: echocardiography, Doppler ultrasound of brachiocephalic arteries, 24-hours ECG monitoring, digital sphygmography of common carotid arteries; CT or MRI of the brain; lipid spectrum. The study group was divided into two subgroups according to the moment of ES ventricular systole occurrence in cardiocycle, regardless of ectopia: subgroup 1 120 patients with ES before the transmitral blood flow peak; subgroup 2 320 patients with ES after the transmitral blood flow peak. We analyzed the development of stroke or TIA during 1 year.
 Results. For most parameters, subgroups 1, 2 and the control group were identical. The important differences were registered in the hemodynamic and kinetic parameters of common carotid arteries. The earlier the ES ventricular systole occurred in cardiocycle, the higher increase of the parameters was observed. During one year of follow-up, stroke and TIA occurred more frequently in subgroup 1.
 Conclusion. ES is an additional risk factor for stroke. The most dangerous is ES with ventricular systole occurrence before transmitral blood flow peak. The wave of the 1st post-extrasystolic contraction causes additional trauma of arterial wall and can become a key factor for instability of atherosclerotic plaques with their defragmentation, embolism and stroke.