a Department of Cardiology , Heart and Lung Center, Helsinki University Hospital, University of Helsinki , Helsinki , Finland.
b Department of Neurology, Clinical Neurosciences , Helsinki University Hospital, University of Helsinki , Helsinki , Finland.
Ann Med. 2017 Nov;49(7):562-568. doi: 10.1080/07853890.2017.1348620. Epub 2017 Jul 14.
Certain electrocardiographic (ECG) abnormalities are associated with ischemic stroke (IS), especially cardioembolic subtype. Besides atrial fibrillation, markers of left ventricular hypertrophy (LVH) or atrial pathology also reflect elevated risk. We studied the association of ECG markers with IS in young adults.
We performed a case-control study including 567 consecutive IS patients aged 15-49 years (inclusion period: 1994-2007) and one or two age- and sex-matched control subjects enrolled during 1978-1980 (n = 1033), and investigated also the stroke aetiologic subgroups. We studied ECGs of all participants for markers of atrial abnormality, i.e. P-terminal force (PTF) on lead V1, interatrial blocks (IAB; P-wave duration ≥110 ms), and LVH. Conditional logistic regression analyses were used.
IAB (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.16-2.13) and PTF combined with LVH (HR: 6.83, 95% CI: 1.65-28.31), were independently associated with IS. LVH, abnormal P-wave (HR: 6.87, 95% CI: 1.97-135.29), PTF, IAB, and combinations of these P-wave abnormalities with LVH - were associated with cardioembolic subtype. Abnormal P-wave and IAB were associated with cryptogenic stroke subtype. In unadjusted analysis, LVH was associated with small-vessel disease subtype.
P-wave abnormalities on ECG were associated with cardioembolic but also with a cryptogenic subtype of IS. Key messages ECG patterns associated with atrial pathology are markers of increased risk of ischemic stroke in young adults. The ECG markers reflecting atrial pathology were seen in patients with cardioembolic and cryptogenic subtypes of ischemic stroke.
某些心电图（ECG）异常与缺血性脑卒中（IS）相关，尤其是心源性栓塞亚型。除了房颤外，左心室肥厚（LVH）或心房病变的标志物也反映出更高的风险。我们研究了心电图标志物与年轻成年人 IS 的关系。
我们进行了一项病例对照研究，纳入了 567 例年龄在 15-49 岁的连续 IS 患者（纳入期：1994-2007 年）和在 1978-1980 年期间纳入的 1 或 2 名年龄和性别匹配的对照者（n=1033），并研究了卒中的病因亚组。我们对所有参与者的心电图进行了心房异常标志物的研究，即 V1 导联的 P 波终末电势（PTF）、房内阻滞（IAB；P 波时限≥110ms）和 LVH。采用条件逻辑回归分析。
IAB（危险比[HR]：1.57，95%置信区间[CI]：1.16-2.13）和 PTF 合并 LVH（HR：6.83，95% CI：1.65-28.31）与 IS 独立相关。LVH、异常 P 波（HR：6.87，95% CI：1.97-135.29）、PTF、IAB 以及这些 P 波异常与 LVH 的组合，与心源性栓塞亚型相关。异常 P 波和 IAB 与隐源性卒中亚型相关。在未调整的分析中，LVH 与小血管疾病亚型相关。
心电图上的 P 波异常与心源性栓塞但也与隐源性 IS 亚型相关。关键信息反映心房病理的心电图模式是年轻成年人缺血性脑卒中风险增加的标志物。反映心房病理的心电图标志物见于心源性栓塞和隐源性缺血性脑卒中亚型的患者中。
