scholarly journals Nonstenotic Carotid Plaque in Embolic Stroke of Undetermined Source

Stroke ◽  
2020 ◽  
Vol 51 (12) ◽  
pp. 3737-3741
Author(s):  
Gerrit M. Grosse ◽  
Jan-Thorben Sieweke ◽  
Saskia Biber ◽  
Nora L. Ziegler ◽  
Maria M. Gabriel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Left Atrial ◽  
Carotid Plaque ◽  
Left Atrial Volume ◽  
Embolic Stroke ◽  
Volume Index ◽  
Atrial Remodeling ◽  
Conduction Time ◽  
Left Atrial Volume Index

Background and Purpose: Approximately one-sixth of all ischemic strokes are attributable to embolic stroke of undetermined source (ESUS). Recent analyses suggest that atrial cardiopathy and nonstenotic carotid plaque (nsCP) may represent 2 distinct underlying causes in patients with ESUS, although both diseases share common risk factors and are pathophysiologically intertwined. In this study, we, therefore, aimed to search for associations between nsCP and markers of atrial remodeling and function in patients with embolic stroke. Methods: Sixty-eight patients with ESUS or atrial fibrillation (AF)-related stroke proven by imaging who underwent comprehensive echocardiographic studies, including measurements of left atrial function and remodeling, were considered. Patients with ESUS underwent a follow-up of at least 1 year after index stroke. For 20 patients with ESUS, NT-proBNP (N-terminal pro-B-type natriuretic peptide) values were available. Presence of nsCP was evaluated considering Duplex sonography and computed tomography angiography and was further categorized in possibly or probably symptomatic nsCP. Results: ESUS patients with nsCP tended to have higher values of septal and lateral total atrial conduction times ( P =0.071 and P =0.072, respectively), left atrial volume index ( P =0.077), and revealed significantly higher strain rates during early diastole ( P =0.013) as well as higher NT-proBNP values ( P =0.010) than ESUS patients without nsCP. Moreover, septal total atrial conduction time was significantly longer in ESUS patients with possibly symptomatic nsCP compared with those without ( P =0.015). Comparison of ESUS with AF patients revealed significantly higher proportions of nsCP ( P =0.010), possibly symptomatic nsCP ( P =0.037), and probably symptomatic nsCP ( P =0.036) in patients with atrial fibrillation-related stroke. In the regression analysis adjusted for vascular risk factors probably symptomatic nsCP remained significantly associated with AF ( P =0.048, odds ratio: 4.46 [95% CI, 1.02–19.56]). Conclusions: Presence of nsCP is associated with AF and markers of left atrial disease in patients with embolic stroke. Therefore, a thorough evaluation regarding atrial cardiopathy and AF in patients with ESUS should not be restricted if nsCP are found, even if high-risk plaque characteristics are evident.

Abstract 13956: Cystatin C Based Estimated Glomerular Filtration Rate is a Feasible Parameter for Incident Stroke in Patients With Atrial Fibrillation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Naoto Hashimoto ◽  
Satoshi Nishiyama ◽  
Tetsu Watanabe ◽  
Masahiro Wanezaki ◽  
Gensai Yamaura ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cystatin C ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Left Atrial Volume ◽  
Atrial Appendage ◽  
Volume Index ◽  
Chads2 Score ◽  
Left Atrial Volume Index ◽  
Ckd Stage

Introduction: Chronic kidney disease (CKD) is an important risk factor of stroke in patients with atrial fibrillation (AF). Since AF patients with high CHADS2 score are likely to be old and have history of TIA or stroke, there could be patients who have sarcopenia. Cystatin C based estimated glomerular filtrarion rate (eGFRcys) is less affected by age, gender and muscle mass compared to creatine based eGFR (eGFRcr). We investigated whether eGFRcys is more closely associated with incident stroke in AF patients compared to eGFRcr. Methods: We performed transthoracic and transesophageal echocardiography and measured eGFRcys and eGFRcr in 349 patients with paroxysmal AF and chronic AF (256 males, 64.4 ± 11.7 years). We excluded those who had severe valvular heart disease and end stage renal desease. There were 42 patients with stroke history. Results: eGFRcys showed better correlation with left atrial volume index, levels of brain natriuretic peptide, von Willebrand factor, and left atrial appendage emptying flow velocity, than eGFRcr. eGFRcys was decreased with increading CHADS2 and CHA2DS2VASc score. Patients with left atrial appendage and/or spontaneous echo contrast had a significantly lower eGFRcys compared to those without. The proportion of patients with stroke was increased with advancing CKD stage in eGFRcys. Although eGFRcys and eGFRcr were associated with stroke in logistic regression analysis, eGFRcys but not eGFRcr was an independent predictor for stroke after adjustment for CHADS2 score. Conclusion: eGFRcys is a feasible parameter for incident stroke in AF patients.

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