Atrial cardiopathy and non-stenotic intracranial complicated atherosclerotic plaque in patients with embolic stroke of undetermined source

2021 ◽  
pp. jnnp-2021-327517
Author(s):  
Lin Tao ◽  
Ying-Jie Dai ◽  
Zi-Yang Shang ◽  
Xiao-Qiu Li ◽  
Xin-Hong Wang ◽  
...  
Keyword(s):  
Atherosclerotic Plaque ◽  
Left Atrial ◽  
Small Vessel Disease ◽  
Troponin T ◽  
High Sensitivity ◽  
Final Analysis ◽  
Embolic Stroke ◽  
P Wave ◽  
Vessel Disease ◽  
High Resolution Mri

ObjectiveTo assess (1) the association between atrial cardiopathy (AC) and non-stenotic intracranial complicated atherosclerotic plaque (NICAP) in patients with embolic stroke of undetermined source (ESUS) or small-vessel disease (SVD), and (2) the performance of previously proposed biomarkers to identify AC as the underlying aetiology in ESUS.MethodsBased on our high-resolution MRI (HR-MRI) cohort, 403 subjects (243 ESUS and 160 SVD) were enrolled in the final analysis. All patients underwent intracranial HR-MRI to assess the presence of ipsilateral NICAP. Biomarkers of AC (ie, P-wave terminal force in lead V1 (PTFV1) on ECG, N-terminal probrain natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T and left atrial diameter) were collected within 24 hours after admission.ResultsAmong patients without ipsilateral NICAP, we found an association between the presence of AC (adjusted OR (aOR): 4.76, 95% CI 2.48 to 9.14), increased PTFV1 (aOR: 5.70, 95% CI: 2.43 to 13.39) and NT-proBNP (aOR: 1.65, 95% CI: 1.16 to 2.35) with ESUS. This association was not evident among patients with ipsilateral NICAP. The discrimination between ESUS versus SVD by AC/AC-related biomarkers was significantly improved after excluding ipsilateral NICAP. Similarly, the discrimination between ESUS and SVD by ipsilateral NICAP was notably augmented after excluding AC, PTFV1 and NT-proBNP.InterpretationAC is more prevalent in patients who had ESUS without ipsilateral NICAP compared with patients with, implying that AC and ipsilateral NICAP are two distinct, competing aetiologies of ESUS. Among the AC biomarkers studied in this analysis, PTFV1 seems to be the most informative.

scholarly journals Evaluation of left atrial mechanics and p-wave dispersion as markers of left atrial cardiopathy in patients of embolic stroke of undetermined source (ESUS)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Masood ◽  
M.M Azharuddin ◽  
S.M.K Ashraf ◽  
S Wahab
Keyword(s):  
Left Atrial ◽  
Wave Dispersion ◽  
Embolic Stroke ◽  
P Wave ◽  
Electromechanical Delay ◽  
P Wave Dispersion ◽  
Atrial Electromechanical Delay ◽  
Wave Duration ◽  
P Wave Duration ◽  
Increased Risk

Abstract Introduction Around 25% of all ischaemic strokes have no known cause despite standard investigations. Most of these cases are suspected to have an embolic source for ischaemia, leading to the moniker of Embolic Stroke of Undetermined Source (ESUS). Recent studies suggest that abnormalities of the left atrium, in the form of atrial cardiopathy, can lead to increased risk of stroke even in the absence of atrial fibrillation (AF), which may be either as precursors to AF or as independent risk factors for the development of left atrial thrombus and subsequent stroke. Purpose The aim of this study was to measure LA electromechanical dissociation, LA volumes and P-wave dispersion as markers of atrial cardiopathy in patients with ESUS to determine whether atrial cardiopathy may be in the causal pathway of ESUS. Methods 28 patients presenting with ischaemic stroke and fulfilling the criteria for ESUS were enrolled into this cross-sectional, observational study. All patients had 24-hour Holter monitoring done to rule out the presence of AF. The control group consisted of 28 age- and gender-matched apparently healthy individuals. On ECG, P-wave Dispersion (PWD) was calculated by subtracting minimum P-wave duration from maximum P-wave duration. On echocardiography, time intervals from the beginning of P-wave to beginning of A' wave from the lateral mitral annulus in tissue doppler imaging was measured as the atrial electromechanical delay. LA volumes were recorded using the Modified Biplane Simpson's method. Statistical analysis was performed using student's t-test, chi-square test, and Pearson's test. Results Baseline demographic and laboratory characteristics were similar between the two groups. Increased PWD (34.14±9.89 ms vs. 27.32±8.95 ms; p=0.01), atrial electromechanical delay (73.32±16.31 ms vs. 63.63±13.59 ms; p=0.02) and LA volumes were observed in patients with ESUS as compared to controls. A significant correlation was also found between these parameters (p<0.01). Discussion According to the results of our study, PWD, atrial electromechanical delay and LA volumes may be novel predictors for ESUS. Atrial cardiopathy is a unique mechanism of thrombo-embolism in ESUS patients and our data establishes its association with ESUS. Further studies will be needed to shed more light on its role in the causality of stroke in the ESUS population. Measurement of electromechanical delay Funding Acknowledgement Type of funding source: None

Abstract WP232: Biomarkers of Atrial Cardiopathy and Atrial Fibrillation Detection on Mobile Continuous Outpatient Telemetry After Cryptogenic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Denise Sebasigari ◽  
Alexander Merkler ◽  
Guo Yang ◽  
Benjamin Kummer ◽  
Gino Gialdini ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Cryptogenic Stroke ◽  
Heart Rhythm ◽  
Population Based ◽  
Embolic Stroke ◽  
P Wave ◽  
Left Atrial Diameter ◽  
New Diagnosis ◽  
Rhythm Monitoring

Background: In population-based studies, biomarkers of atrial dysfunction or “cardiopathy” have been shown to be associated with embolic stroke risk. However, it is unclear if this risk is mediated by undiagnosed paroxysmal atrial fibrillation or flutter (AF). We aim to determine whether atrial cardiopathy biomarkers predict atrial fibrillation on continuous heart-rhythm monitoring after embolic stroke of undetermined source (ESUS). Methods: This was a single-center retrospective study including all patients who met consensus criteria for ESUS and who underwent 30 days of ambulatory heart-rhythm monitoring looking for AF between Jan 1 st , 2013 and Dec 31 st , 2015. We reviewed medical records for clinical, radiographic, and cardiac variables. The primary outcome was new diagnosis of AF detected during heart-rhythm monitoring. The primary predictors were atrial biomarkers: left atrial diameter on echocardiography, P-wave terminal force in ECG lead V1 , and PR interval on ECG. Multiple logistic regression was used to assess the relationship between atrial biomarkers and AF detection. Results: Among 196 eligible patients, 23 (11.7%) were diagnosed with AF. In unadjusted analyses, patients with AF were older (72.4 vs. 61.4 years, p < 0.001) and had larger left atrial diameter (39.2 vs. 35.7 mm, p = 0.03). In a multivariable model including variables significant on univariate analyses, the only predictor of AF was age ≥ 60 years (odds ratio, 3.0; 95% CI, 1.06-8.5; p = 0.04). Atrial biomarkers were not associated with AF detection. Conclusion: Atrial biomarkers were not associated with AF after ESUS. This suggests that previously reported associations between these markers and stroke may reflect independent cardiac pathways leading to stroke. Prospective studies are needed to investigate these mechanisms and study anticoagulation versus antiplatelet treatment for secondary stroke prevention in patients with ESUS and atrial cardiopathy.

Abstract T MP57: Coexisting Cerebrovascular Disease and Risk of Occult Atrial Fibrillation in Patients With Embolic Stroke of Undetermined Source

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Esther Rojo ◽  
María Sandín-Fuentes ◽  
Ana I Calleja ◽  
Gabriel Largaespada ◽  
Elisa Cortijo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Secondary Prevention ◽  
Cerebrovascular Disease ◽  
Cox Regression ◽  
Small Vessel Disease ◽  
Brain Magnetic Resonance Imaging ◽  
Embolic Stroke ◽  
Small Vessel ◽  
Large Artery ◽  
Vessel Disease

Background and objective: Secondary prevention after embolic stroke of undetermined source (ESUS) remains a clinical problem. Presence of asymptomatic cerebral large-artery atherosclerosis or small vessel disease could be aprioristically taken as an indicator of a lower risk for an occult cardiac source of emboli, thus influencing our secondary prevention strategy. We aimed to study the relationship between presence and degree of coexisting cerebrovascular disease and the risk of occult paroxysmal atrial fibrillation (OPAF) in ESUS patients. Methods: Longitudinal prospective study in patients fulfilling ESUS criteria after complete neurovascular and cardiac diagnostic workup, who were implanted with a subcutaneous REVEAL-XT loop-recorder to detect OPAF and followed-up for≥ 6 months. At baseline, cerebral large-artery atherosclerosis was assessed with cervical and transcranial ultrasound. Brain magnetic resonance imaging was used to evaluate small vessel disease. Periventricular (PV) and subcortical (SC) white matter hiperintensities (WMH) were categorized using the Fazekas score. Results: We studied 136 ESUS patients from October 2010 to December 2013 (71 men, mean age 67), who were followed-up for a mean time of 594 days. OPAF was detected in 56 (41%) of them. No relationship was found between extracranial or intracranial atherosclerosis and OPAF. Kaplan-Meier curves and crude Cox-regression analyses found associations between OPAF risk and age, smoking, CHA2DS2VASC score, presence of lacunar infarctions, and presence and degree of PVWMH & SCWMH. A multivariable-adjusted Cox regression model identified grade 2-3 PVWMH (HR 3.6, [2.0-6.5], p<0.001) and age as independent predictors of OPAF. Conclusion: Coexisting small vessel disease, specifically in the form of periventricular WMH, is a predictor of OPAF in ESUS patients. Presence of large-artery atherosclerosis does not lower the risk for OPAF. Therefore, OPAF should be actively pursued in ESUS patients regardless the coexistence of asymptomatic cerebrovascular disease.

scholarly journals High-Sensitivity Cardiac Troponin T for Risk Stratification in Patients With Embolic Stroke of Undetermined Source

Stroke ◽  
2020 ◽  
Vol 51 (8) ◽  
pp. 2386-2394 ◽  
Author(s):  
Jan F. Scheitz ◽  
Guillaume Pare ◽  
Lesly A. Pearce ◽  
Hardi Mundl ◽  
W. Frank Peacock ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Risk Stratification ◽  
Cardiac Troponin ◽  
Troponin T ◽  
High Sensitivity ◽  
Embolic Stroke ◽  
Cardiac Troponin T ◽  
Reference Limit ◽  
End Point ◽  
Upper Reference Limit

Background and Purpose: Optimal secondary prevention for patients with embolic stroke of undetermined source (ESUS) remains unknown. We aimed to assess whether high-sensitivity cardiac troponin T (hs-cTnT) levels are associated with major vascular events and whether hs-cTnT may identify patients who benefit from anticoagulation following ESUS. Methods: Data were obtained from the biomarker substudy of the NAVIGATE ESUS trial, a randomized controlled trial testing the efficacy of rivaroxaban versus aspirin for secondary stroke prevention in ESUS. Patients were dichotomized at the hs-cTnT upper reference limit (14 ng/L, Gen V, Roche Diagnostics). Cox proportional hazard models were computed to explore the association between hs-cTnT, the combined cardiovascular end point (recurrent stroke, myocardial infarction, systemic embolism, cardiovascular death), and recurrent ischemic stroke. Results: Among 1337 patients enrolled at 111 participating centers in 18 countries (mean age 67±9 years, 61% male), hs-cTnT was detectable in 95% and at/above the upper reference limit in 21%. During a median follow-up of 11 months, the combined cardiovascular end point occurred in 68 patients (5.0%/y, rivaroxaban 28 events, aspirin 40 events; hazard ratio, 0.67 [95% CI, 0.41–1.1]), and recurrent ischemic stroke occurred in 50 patients (4.0%/y, rivaroxaban 16 events, aspirin 34 events, hazard ratio 0.45 [95% CI, 0.25–0.81]). Annualized combined cardiovascular end point rates were 8.2% (9.5% rivaroxaban, 7.0% aspirin) for those above hs-cTnT upper reference limit and 4.8% (3.1% rivaroxaban, 6.6% aspirin) below with a significant treatment modification ( P =0.04). Annualized ischemic stroke rates were 4.7% above hs-cTnT upper reference limit and 3.9% below, with no suggestion of an interaction between hs-cTnT and treatment ( P =0.3). Conclusions: In patients with ESUS, hs-cTnT was associated with increased cardiovascular event rates. While fewer recurrent strokes occurred in patients receiving rivaroxaban, outcomes were not stratified by hs-cTn results. Our findings support using hs-cTnT for cardiovascular risk stratification but not for decision-making regarding anticoagulation therapy in patients with ESUS. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02313909.

scholarly journals Recent-onset atrial fibrillation: a study exploring the elements of Virchow’s triad after cardioversion

2021 ◽  
Author(s):  
Panagiotis Arvanitis ◽  
Anna-Karin Johansson ◽  
Mats Frick ◽  
Helena Malmborg ◽  
Spyridon Gerovasileiou ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Troponin T ◽  
High Sensitivity ◽  
Cardiac Biomarkers ◽  
Prior History ◽  
Recent Onset ◽  
Reactive Protein ◽  
Peak Longitudinal Strain ◽  
History Of

Abstract Purpose Atrial fibrillation (AF) imposes an inherent risk for stroke and silent cerebral emboli, partly related to left atrial (LA) remodeling and activation of inflammatory and coagulation systems. The aim was to explore the effects of cardioversion (CV) and short-lasting AF on left atrial hemodynamics, inflammatory, coagulative and cardiac biomarkers, and the association between LA functional recovery and the presence of a prior history of AF. Methods Patients referred for CV within 48 h after AF onset were prospectively included. Echocardiography and blood sampling were performed immediately prior, 1–3 h after, and at 7–10 days after CV. The presence of chronic white matter hyperintensities (WMH) on magnetic resonance imaging was related to biomarker levels. Results Forty-three patients (84% males), aged 55±9.6 years, with median CHA2DS2-VASc score 1 (IQR 0–1) were included. The LA emptying fraction (LAEF), LA peak longitudinal strain during reservoir, conduit, and contractile phases improved significantly after CV. Only LAEF normalized within 10 days. Interleukin-6, high-sensitivity cardiac-troponin-T (hs-cTNT), N-terminal-pro-brain-natriuretic peptide, prothrombin-fragment 1+2 (PTf1+2), and fibrinogen decreased significantly after CV. There was a trend towards higher C-reactive protein, hs-cTNT, and PTf1+2 levels in patients with WMH (n=21) compared to those without (n=22). At 7–10 days, the LAEF was significantly lower in patients with a prior history of AF versus those without. Conclusion Although LA stunning resolved within 10 days, LAEF remained significantly lower in patients with a prior history of AF versus those without. Inflammatory and coagulative biomarkers were higher before CV, but subsided after 7–10 days, which altogether might suggest an enhanced thrombogenicity, even in these low-risk patients.

scholarly journals In-depth haemodynamic phenotyping of pulmonary hypertension due to left heart disease

2018 ◽  
Vol 51 (5) ◽  
pp. 1800067 ◽  
Author(s):  
Christian Gerges ◽  
Mario Gerges ◽  
Pierre Fesler ◽  
Anna Maria Pistritto ◽  
Nicholas P. Konowitz ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Left Atrial ◽  
Small Vessel Disease ◽  
Idiopathic Pulmonary Arterial Hypertension ◽  
Small Vessel ◽  
Left Heart ◽  
Vessel Disease ◽  
Right Ventricular Afterload ◽  
Ventricular Afterload ◽  
Pulmonary Arterial

The commonest cause of pulmonary hypertension (PH) is left heart disease (LHD). The current classification system for definitions of PH-LHD is under review. We therefore performed prospective in-depth invasive haemodynamic phenotyping in order to assess the site of increased pulmonary vascular resistance (PVR) in PH-LHD subsets.Based on pulmonary artery occlusion waveforms yielding an estimate of the effective capillary pressure, we partitioned PVR in larger arterial (Rup, upstream resistance) and small arterial plus venous components (Rds, downstream resistance). In the case of small vessel disease, Rup decreases and Rds increases. Inhaled nitric oxide (NO) testing was used to assess acute vasoreactivity.Right ventricular afterload (PVR, pulmonary arterial compliance and effective arterial elastance) was significantly higher in combined post- and pre-capillary PH (Cpc-PH, n=35) than in isolated post-capillary PH (Ipc-PH, n=20). Right ventricular afterload decreased during inhalation of NO in Cpc-PH and idiopathic pulmonary arterial hypertension (n=31), but remained unchanged in Ipc-PH. Rup was similar in Cpc-PH (66.8±10.8%) and idiopathic pulmonary arterial hypertension (65.0±12.2%; p=0.530) suggesting small vessel disease, but significantly higher in Ipc-PH (96.5±4.5%; p<0.001) suggesting upstream transmission of elevated left atrial pressure.Right ventricular afterload is driven by elevated left atrial pressure in Ipc-PH and is further increased by elevated small vessel resistance in Cpc-PH. Cpc-PH is responsive to inhaled NO. Our data support current definitions of PH-LHD subsets.

scholarly journals Association of Aortic Compliance and Brachial Endothelial Function with Cerebral Small Vessel Disease in Type 2 Diabetes Mellitus Patients: Assessment with High-Resolution MRI

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Yan Shan ◽  
Jiang Lin ◽  
Pengju Xu ◽  
Mengsu Zeng ◽  
Huandong Lin ◽  
...  
Keyword(s):  
High Resolution ◽  
Endothelial Function ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Regression Analyses ◽  
Aortic Compliance ◽  
Vessel Disease ◽  
High Resolution Mri

Objective. To assess the possible association of aortic compliance and brachial endothelial function with cerebral small vessel disease in type 2 diabetes mellitus (DM2) patients by using 3.0 T high-resolution magnetic resonance imaging.Methods. Sixty-two clinically confirmed DM2 patients (25 women and 37 men; mean age:56.8±7.5years) were prospectively enrolled for noninvasive MR examinations of the aorta, brachial artery, and brain. Aortic arch pulse wave velocity (PWV), flow-mediated dilation (FMD) of brachial artery, lacunar brain infarcts, and periventricular and deep white matter hyperintensities (WMHs) were assessed. Pearson and Spearman correlation analysis were performed to analyze the association between PWV and FMD with clinical data and biochemical test results. Univariable logistic regression analyses were used to analyze the association between PWV and FMD with cerebral small vessel disease. Multiple logistic regression analyses were used to find out the independent predictive factors of cerebral small vessel disease.Results. Mean PWV was6.73±2.00 m/s and FMD was16.67±9.11%. After adjustment for compounding factors, PWV was found significantly associated with lacunar brain infarcts (OR = 2.00; 95% CI: 1.14–3.2;P<0.05) and FMD was significantly associated with periventricular WMHs (OR = 0.82; 95% CI: 0.71–0.95;P<0.05).Conclusions. Quantitative evaluation of aortic compliance and endothelial function by using high-resolution MRI may be potentially useful to stratify DM2 patients with risk of cerebral small vessel disease.

scholarly journals Major impact of left auricular cardiopathy when associated to supraventricular ectopy?

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
C Marques Pires ◽  
AR Silva ◽  
P Medeiros ◽  
I Campos ◽  
C Oliveira ◽  
...  
Keyword(s):  
Diagnostic Test ◽  
Test Performance ◽  
Left Atrial ◽  
Cox Regression ◽  
Composite Endpoint ◽  
Embolic Stroke ◽  
P Wave ◽  
Stroke Recurrence ◽  
Diagnostic Test Performance ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Left atrial cardiopathy (LAC) is an independent predictor of atrial fibrillation (FA) and embolic stroke. It is more frequent in patients with embolic stroke of undetermined source (ESUS) than in non-embolic strokes. The current definition doesn’t include supraventricular ectopy. AIM The aim of this work was to describe the importance of LAC in ESUS and to study the impact of adding the number of atrial premature complexes per hour (APC/h) to LAC criteria. METHODS Retrospective analysis of 123 ESUS patients (pts) admitted to Neurology service from 2014 to 2019. LAC was defined according to two criteria (LAC2: severe left atrial enlargement or p-wave terminal force in lead V1 [PTFV1] &gt;5000 µV*ms) or 3 criteria (LAC3: additionally, &gt;30 APC/h). Survival analysis for the occurrence of AF, stroke recurrence and death according to LAC2 and LAC3. Diagnostic test performance analysis for each criterion with ROC curves. RESULTS 43 (35%) of the ESUS pts had LAC2. Pts with LAC2 (35.0%) were older (p = 0.007), more frequently had hypertension (p = 0.004) and lower total cholesterol levels (p = 0.044) than patients without LAC2. The incidence of AF (median follow-up 21 months, IQR = 9-35) was higher both in LAC2 (p = 0.038) and LAC3 (p = 0.001). There were no differences in stroke recurrence or death between patients with or without LAC2 or 3. Among the 3 atrial dysfunction criteria included in LAC3 definition, the number of APC/h was associated with a higher area under the curve for the occurrence of AF (AUC = 0.822). Cox regression revealed that PTFV1 &gt; 5000 µV·ms (HR = 5.12, IC95%=1.28-20.56, p = 0.021) and &gt;30 APC/h (HR = 13.02, IC95%=3.57-47.56) were independent predictors of AF. In addition, the single predictor of the composite endpoint (occurrence of AF, stroke recurrence and death) was &gt;30 APC/h (HR = 5.2, p &lt; 0,001). CONCLUSION In ESUS pts, the subgroup with LAC2 had different clinical characteristics and a higher AF incidence. APC/h were also independently associated with AF incidence and had better diagnostic test performance than the other criteria. In sum, APC/h inclusion as a diagnostic criterion for LAC should be considered and may help in a better therapeutic approach.

scholarly journals Prevalence of Microembolic Signals in Embolic Stroke of Undetermined Source and Other Subtypes of Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (2) ◽  
pp. 655-658 ◽  
Author(s):  
Eiko Higuchi ◽  
Sono Toi ◽  
Yuka Shirai ◽  
Takao Hoshino ◽  
Kentaro Ishizuka ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Small Vessel Disease ◽  
Univariate Analysis ◽  
Cerebral Small Vessel Disease ◽  
Embolic Stroke ◽  
Small Vessel ◽  
Large Artery ◽  
Vessel Disease ◽  
Ischemic Attack

Background and Purpose— Embolic stroke of undetermined source (ESUS) has been proposed to cause thromboembolic infarction from unknown but potential embolic sources. However, an embolus remains undetected in ESUS. The goal of this study was to characterize the prevalence and risk factors of microembolic signals (MESs) in ESUS. Methods— We examined 108 patients with acute ischemic stroke in the internal carotid artery territory or transient ischemic attack within 14 days of symptom onset and who were admitted to our hospital between April 2017 and March 2019. MESs were monitored in the middle cerebral artery on transcranial Doppler for 60 minutes. We examined the prevalence and number of MES in ESUS and other stroke subtypes, such as cardioembolism, large artery atherosclerosis, cerebral small vessel disease, and transient ischemic attack. The present study was registered in University Hospital Medical Information Network Clinical Trials Registry (UMIN000031913). Results— MESs were detected in 33 (31%) of 108 patients. ESUS showed the highest proportion (12/24 [50%]), followed by large artery atherosclerosis (8/20 [40%]), cardioembolism (6/18 [33%]), transient ischemic attack (4/24 [17%]), and cerebral small vessel disease (3/21 [14%]). Univariate analysis showed that higher systolic blood pressure, body mass index, hemoglobin A1c, and ESUS were significantly associated with MES. In multiple logistic regression analysis, ESUS remained significantly associated with MES after adjustment for described covariates from univariate analysis (odds ratio, 2.86 [95% CI, 1.01–8.08]). Conclusions— This study demonstrated significant association of ESUS with MES, supporting the embolic nature of this stroke subtype. Registration— URL: https://upload.umin.ac.jp . Unique identifier: UMIN000031913.

Sign in / Sign up

Export Citation Format

Share Document