Left ventricular wall motion abnormality is associated with cryptogenic stroke

Abstract

Background Left ventricular wall motion abnormality (LVWMA) unrelated to known cardiac risk factors is an uncertain risk for stroke. Aims We evaluated whether LVWMA was associated with cryptogenic stroke. Methods This retrospective, observational study included 4316 acute ischemic stroke patients, and the association between cryptogenic stroke and LVWMA was examined in comparison with other stroke subtypes. Results The prevalence of LVWMA was 10.0% in the study population. In a fully adjusted, binary logistic regression, LVWMA was independently associated with cryptogenic stroke compared with stroke from large artery atherosclerosis (odds ratio = 1.627, 95% confidence interval = 1.129–2.345), small vessel occlusion (odds ratio = 1.948, 95% confidence interval = 1.261–3.010), or other causes (odds ratio = 4.950, 95% confidence interval = 1.145–21.412). Meanwhile, the association of LVWMA with cryptogenic stroke was similar to the associations of LVWMA with cardioembolic stroke (odds ratio = 0.758, 95% confidence interval = 0.525–1.094) and stroke with two or more causes (odds ratio = 0.992, 95% confidence interval = 0.609–1.615). In multinomial regression, LVWMA had the strongest association with cardioembolic stroke, followed by cryptogenic stroke and stroke from two or more causes. The strength of the associations with LVWMA then decreased sequentially in patients with large artery atherosclerosis, small vessel occlusion, and other causes. Conclusions The association of LVWMA with cryptogenic stroke was comparable to that of LVWMA with cardioembolic stroke but stronger than that of LVWMA with non-cardioembolic stroke. LVWMA unrelated to known cardiac risk factors could be considered an independent risk factor for cryptogenic stroke.

Partitioning risk factors for embolic stroke of undetermined source using exploratory factor analysis

“…There is growing evidence of a role for LVWMA in ESUS pathology. 4,19,20 The finding of predominantly heart-related clustering extended to Cardiac 2 where reduced LVDD and increased LVMI featured. The moderate correlation between Cardiac 1 and 2 reflects an association between these variables and Cardiac 1 items.…”

Cardiac CT for intra-cardiac thrombus detection in embolic stroke of undetermined source (ESUS)

“…The association between RWMA and IS recurrence has been previously debated without clear conclusion. [35][36][37] In current practice, regional or moderate global LV dysfunction is not considered as an indication for AC. Interestingly, a recent subgroup analysis of LVSD cases from the NAVIGATE-ESUS study (defined as regional and/ or global LVSD), has suggested that in this subgroup, AC is superior to aspirin in reducing the risk of recurrent stroke.…”

Utility of transesophageal echocardiography in the identification and treatment of occult mechanisms of cerebral infarction

“…To optimize sensitivity of capturing relevant TEE ndings, and because TEE ndings could have contributed to a classi cation of stroke mechanism as cardioembolic, patients with non-AF CSE and cryptogenic stroke were consolidated into a single patient group for all analyses. Furthermore, the designation of stroke mechanism as cryptogenic or cardioembolic in patients with severe systolic dysfunction, PFO, or other intracardiac pathologies or variants remains controversial [10][11][12]; therefore, suspected non-AF CSE and cryptogenic patients were consolidated. (Subgroup analyses of ndings based on non-AF CSE and cryptogenic stroke are also presented for the sake of transparency.)…”