Abstract
BackgroundCardio embolism and cerebrovascular atherosclerosis are two major mechanisms of stroke. Studies investigating associations between advanced echocardiographic parameters and stroke mechanisms are limited.MethodsThis study is a standardized review of 633 patients admitted to the stroke service of a tertiary care hospital following a standardized stroke investigation and management pathway. Stroke subtypes were characterized using the Causative Classification System, using the hospitals online radiologic archival system with CCS certified stroke investigators. Patients with two mechanisms were excluded.ResultsPatients with cardioembolic stroke had a higher proportion of atrial fibrillation (p < 0.001), acute myocardial infarction (p < 0.001) and ischemic heart disease (p < 0.001). On electrocardiogram (ECG) and transthoracic Echo (TTE), patients with cardioembolic stroke had a greater atrial fibrillation (p < .00), left ventricular thrombus (p < .00), left ventricular ejection fraction <30% (p < .00) and global hypokinesia (p < .00) Patients with cardioembolic stroke had higher mean left atrial volume indices (LAVi) (p < 0.001), mean left ventricular mass indices (LVMi) (p < 0.05) and mean left atrial diameters (LAD) (p < 0.05). At LAVi of 29–33 ml/m2, the risk of atherothrombotic stroke increased. The risk of cardioembolic stroke increased with LAVi of 34 ml/m2 and above.ConclusionLeft atrial volume indices may be linked to specific stroke phenotype. At mild increases in left atrial dimensions, the risks of atherosclerotic stroke are high, and probably reflect hypertension as the unifying mechanism. Further increases in left atrial dimensions shifts the risk towards cardioembolic stroke.
Highlights
Cardio embolism and cerebrovascular atherosclerosis are two major mechanisms of stroke
The underlying pathological processes are different in the two subtypes; while advanced atherosclerotic stenosis is deemed to be the major mechanism in atherothrombotic stroke, it is the underlying cardiac abnormalities with relatively preserved architecture of blood vessels that eventually manifests as cardioembolic strokes
As a standard of care, all admitted stroke patients are evaluated by a consultant neurologist and undergo stroke workup that includes neuroimaging via MRI and MRA, electrocardiogram (ECG), transthoracic echocardiography (TTE), Carotid Doppler Sonography and Biochemical workup such as serum glucose, lipid profile, blood urea nitrogen and serum creatinine
Summary
Cardio embolism and cerebrovascular atherosclerosis are two major mechanisms of stroke. The underlying pathological processes are different in the two subtypes; while advanced atherosclerotic stenosis is deemed to be the major mechanism in atherothrombotic stroke, it is the underlying cardiac abnormalities with relatively preserved architecture of blood vessels that eventually manifests as cardioembolic strokes. Atherosclerosis leading to hypertension is mirrored on an echocardiogram as left ventricular hypertrophy [4]. Recent studies have reported left atrial diameter and left atrial volume index to be associated with chronic hypertension and stroke [7]. These values have helped in predicting ischemic stroke their association with specific stroke subtypes has not been established
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