Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Division of Cardiology, Department of Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
J Stroke Cerebrovasc Dis. 2020 Aug;29(8):104975. doi: 10.1016/j.jstrokecerebrovasdis.2020.104975. Epub 2020 Jun 9.
Structural left atrial and ventricular abnormalities on the electrocardiogram (ECG) and transthoracic echocardiogram (TTE) at the time of ischemic stroke have been associated with morbidity and mortality. Yet, the prognostic impact of the same in embolic stroke of undetermined source (ESUS), a relevant subtype of ischemic stroke with a unique pathophysiology, has not been well studied to date. Our aim was to assess the predictive impact of left atrio-ventricular ECG and TTE abnormalities on one-year hospital readmission after ESUS from an ongoing single center prospective stroke registry in the U.S.
We identified 369 ESUS patients who had at least 1 year of complete follow-up between 2013 and 2018. We examined the association of abnormal left atrio-ventricular findings on ECG and TTE, as well as basic demographic and clinical characteristics, measured at index admission with time to 1-year hospital readmission using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards regression.
Recurrent ischemic stroke and cardiovascular causes constituted 60% of all readmissions. Patients with left atrial dilation on TTE were more likely to readmitted within 1 year (HR 1.51; 95% CI, 1.04-2.21). Bundle branch block, pathologic Q-wave, and troponin elevation curves diverged, but were not significantly associated with readmission (log-rank p=0.34, p=0.08, p=0.42, respectively).
Following ESUS, left atrial dilation on TTE was associated with 1-year overall hospital readmission, of which cardiovascular and cerebrovascular ischemic events, and heart failure were a notable proportion. Our data support ongoing studies of atrial cardiopathy in ESUS patients.
心电图（ECG）和经胸超声心动图（TTE）显示的结构性左心房和心室异常与缺血性卒中的发病率和死亡率有关。然而，在栓塞性卒中来源不明（ESUS）中，相同结构的预后影响尚未得到充分研究，ESUS 是一种具有独特病理生理学的相关缺血性卒中亚型。我们的目的是评估美国正在进行的单中心前瞻性卒中登记中，ESUS 后一年的住院再入院的左心房-心室 ECG 和 TTE 异常的预测影响。
我们确定了 369 名 ESUS 患者，他们在 2013 年至 2018 年期间至少有 1 年的完整随访。我们检查了在指数入院时测量的异常左心房-心室心电图和 TTE 以及基本人口统计学和临床特征与 1 年住院再入院时间的关联，使用 Kaplan-Meier 曲线、对数秩检验和 Cox 比例风险回归。
复发性缺血性卒中和心血管原因构成了所有再入院的 60%。TTE 显示左心房扩张的患者在 1 年内更有可能再次入院（HR 1.51；95%CI，1.04-2.21）。束支传导阻滞、病理性 Q 波和肌钙蛋白升高曲线发散，但与再入院无显著相关（对数秩检验 p=0.34、p=0.08、p=0.42）。
在 ESUS 后，TTE 上的左心房扩张与 1 年总的住院再入院相关，其中心血管和脑血管缺血事件以及心力衰竭是一个显著的比例。我们的数据支持对 ESUS 患者心房心肌病的持续研究。
