The electrocardiogram in young adult ischemic stroke

Forskningsoutput: AvhandlingDoktorsavhandlingSamling av artiklar

Sammanfattning

Electrocardiography (ECG) is a routine diagnostic method for all young ischemic stroke (IS) patients, although the relevance of its findings is as yet poorly known. A diagnostic work-up to reveal etiology in a young IS patient includes many cardiac diagnostic methods, as finding a high-risk source of cardioembolism (HRCE) will influence the secondary prevention after IS, and also provides a marker for high risk of recurrent events and mortality. IS per se is a disastrous event, and recurrent cardiovascular events may worsen the situation further. Identifying patients at a high risk of recurrent events is therefore important. The Helsinki Young Stroke Registry (HYSR) includes all 15- to 49-yearold IS patients treated at the Helsinki University Hospital between 1994 and 2007. Blinded to other current clinical data, we analyzed 12-lead resting ECGs obtained 1 to 14 days after IS in 690 patients. We used logistic regression, adjusted for demographic and clinical confounders, to investigate, in 78 patients, what ECG findings are related to an etiology of HRCE (Study I). We investigated what ECG findings bear an increased risk of new cardiovascular events (Study II) and mortality (Study III), using Cox regression adjusted for demographic confounders and comorbidities. We also collected a cohort of stroke-free control subjects in order to study the association of ECG markers with IS at young age, with stratified analysis according to IS subtype (Study IV). Of our IS patient cohort (median age 41 years, 63% male), 35% showed some ECG abnormality. The most common abnormalities were T-wave inversions (16%), left ventricular hypertrophy (LVH) (14%), prolonged P-waves (13%), and prolonged corrected QT interval (QTc) (12%). Of all IS patients, 3% had atrial fibrillation (AF), and 4% P-terminal force in lead V1 (PTF). A longer QRS complex duration, a longer QTc, and wider QRS-T-angle were independently associated with HRCE. Interestingly, PTF had the strongest independent association with HRCE (hazard ratio 43.18). After a median follow-up of 8.8 years, 26.4% of patients experienced some cardiovascular event. 14.6% suffered a recurrent stroke, and 16.1% died; 9.1% died from cardiovascular causes. ECG parameters associated with recurrent cardiovascular events were bundle branch blocks, PTF, LVH, and a broader QRS complex. No ECG parameter was associated with stroke recurrence. A higher heart rate, a shorter P-wave and longer QTc were associated with increased all-cause mortality. Only a higher heart rate was associated with death from cardiovascular causes. In the case-control study, abnormal P-waves, PTF, interatrial block – and combinations of these P-wave abnormalities with LVH – were associated with cardioembolic IS. Abnormal P-wave and IAB were also associated with cryptogenic IS; and LVH was associated with small-vessel disease (SVD) subtype. In conclusion, ECG in young IS patients provides information on IS etiology, risk of recurrent events, and mortality. P-wave abnormalities and ECG markers of LVH are more frequent in young IS patients than in stroke-free controls, suggesting they may be markers of increased IS risk, which is mostly explained by the HRCE subgroup.
Originalspråkengelska
Handledare
  • Lehto, Mika, Handledare
  • Putaala, Jukka, Handledare
UtgivningsortHelsinki
Förlag
Tryckta ISBN978-951-51-4030-2
Elektroniska ISBN978-951-51-4031-9
StatusPublicerad - 2018
MoE-publikationstypG5 Doktorsavhandling (artikel)

Vetenskapsgrenar

  • 3121 Inre medicin

Citera det här

@phdthesis{a8b8e8c37cb440559d148ab9f3932137,
title = "The electrocardiogram in young adult ischemic stroke",
abstract = "Electrocardiography (ECG) is a routine diagnostic method for all young ischemic stroke (IS) patients, although the relevance of its findings is as yet poorly known. A diagnostic work-up to reveal etiology in a young IS patient includes many cardiac diagnostic methods, as finding a high-risk source of cardioembolism (HRCE) will influence the secondary prevention after IS, and also provides a marker for high risk of recurrent events and mortality. IS per se is a disastrous event, and recurrent cardiovascular events may worsen the situation further. Identifying patients at a high risk of recurrent events is therefore important. The Helsinki Young Stroke Registry (HYSR) includes all 15- to 49-yearold IS patients treated at the Helsinki University Hospital between 1994 and 2007. Blinded to other current clinical data, we analyzed 12-lead resting ECGs obtained 1 to 14 days after IS in 690 patients. We used logistic regression, adjusted for demographic and clinical confounders, to investigate, in 78 patients, what ECG findings are related to an etiology of HRCE (Study I). We investigated what ECG findings bear an increased risk of new cardiovascular events (Study II) and mortality (Study III), using Cox regression adjusted for demographic confounders and comorbidities. We also collected a cohort of stroke-free control subjects in order to study the association of ECG markers with IS at young age, with stratified analysis according to IS subtype (Study IV). Of our IS patient cohort (median age 41 years, 63{\%} male), 35{\%} showed some ECG abnormality. The most common abnormalities were T-wave inversions (16{\%}), left ventricular hypertrophy (LVH) (14{\%}), prolonged P-waves (13{\%}), and prolonged corrected QT interval (QTc) (12{\%}). Of all IS patients, 3{\%} had atrial fibrillation (AF), and 4{\%} P-terminal force in lead V1 (PTF). A longer QRS complex duration, a longer QTc, and wider QRS-T-angle were independently associated with HRCE. Interestingly, PTF had the strongest independent association with HRCE (hazard ratio 43.18). After a median follow-up of 8.8 years, 26.4{\%} of patients experienced some cardiovascular event. 14.6{\%} suffered a recurrent stroke, and 16.1{\%} died; 9.1{\%} died from cardiovascular causes. ECG parameters associated with recurrent cardiovascular events were bundle branch blocks, PTF, LVH, and a broader QRS complex. No ECG parameter was associated with stroke recurrence. A higher heart rate, a shorter P-wave and longer QTc were associated with increased all-cause mortality. Only a higher heart rate was associated with death from cardiovascular causes. In the case-control study, abnormal P-waves, PTF, interatrial block – and combinations of these P-wave abnormalities with LVH – were associated with cardioembolic IS. Abnormal P-wave and IAB were also associated with cryptogenic IS; and LVH was associated with small-vessel disease (SVD) subtype. In conclusion, ECG in young IS patients provides information on IS etiology, risk of recurrent events, and mortality. P-wave abnormalities and ECG markers of LVH are more frequent in young IS patients than in stroke-free controls, suggesting they may be markers of increased IS risk, which is mostly explained by the HRCE subgroup.",
keywords = "Electrocardiography, Stroke, +complications, +mortality, +physiopathology, Brain Ischemia, Young Adult, Heart Rate, Atrial Fibrillation, Interatrial Block, Hypertrophy, Left Ventricular, Embolism, Secondary Prevention, Biomarkers, Cardiovascular Diseases, +epidemiology, Heart Diseases, 3121 Internal medicine",
author = "Jani Pirinen",
note = "M1 - 95 s. + liitteet",
year = "2018",
language = "English",
isbn = "978-951-51-4030-2",
publisher = "[J. Pirinen]",
address = "Finland",

}

The electrocardiogram in young adult ischemic stroke. / Pirinen, Jani.

Helsinki : [J. Pirinen], 2018. 95 s.

Forskningsoutput: AvhandlingDoktorsavhandlingSamling av artiklar

TY - THES

T1 - The electrocardiogram in young adult ischemic stroke

AU - Pirinen, Jani

N1 - M1 - 95 s. + liitteet

PY - 2018

Y1 - 2018

N2 - Electrocardiography (ECG) is a routine diagnostic method for all young ischemic stroke (IS) patients, although the relevance of its findings is as yet poorly known. A diagnostic work-up to reveal etiology in a young IS patient includes many cardiac diagnostic methods, as finding a high-risk source of cardioembolism (HRCE) will influence the secondary prevention after IS, and also provides a marker for high risk of recurrent events and mortality. IS per se is a disastrous event, and recurrent cardiovascular events may worsen the situation further. Identifying patients at a high risk of recurrent events is therefore important. The Helsinki Young Stroke Registry (HYSR) includes all 15- to 49-yearold IS patients treated at the Helsinki University Hospital between 1994 and 2007. Blinded to other current clinical data, we analyzed 12-lead resting ECGs obtained 1 to 14 days after IS in 690 patients. We used logistic regression, adjusted for demographic and clinical confounders, to investigate, in 78 patients, what ECG findings are related to an etiology of HRCE (Study I). We investigated what ECG findings bear an increased risk of new cardiovascular events (Study II) and mortality (Study III), using Cox regression adjusted for demographic confounders and comorbidities. We also collected a cohort of stroke-free control subjects in order to study the association of ECG markers with IS at young age, with stratified analysis according to IS subtype (Study IV). Of our IS patient cohort (median age 41 years, 63% male), 35% showed some ECG abnormality. The most common abnormalities were T-wave inversions (16%), left ventricular hypertrophy (LVH) (14%), prolonged P-waves (13%), and prolonged corrected QT interval (QTc) (12%). Of all IS patients, 3% had atrial fibrillation (AF), and 4% P-terminal force in lead V1 (PTF). A longer QRS complex duration, a longer QTc, and wider QRS-T-angle were independently associated with HRCE. Interestingly, PTF had the strongest independent association with HRCE (hazard ratio 43.18). After a median follow-up of 8.8 years, 26.4% of patients experienced some cardiovascular event. 14.6% suffered a recurrent stroke, and 16.1% died; 9.1% died from cardiovascular causes. ECG parameters associated with recurrent cardiovascular events were bundle branch blocks, PTF, LVH, and a broader QRS complex. No ECG parameter was associated with stroke recurrence. A higher heart rate, a shorter P-wave and longer QTc were associated with increased all-cause mortality. Only a higher heart rate was associated with death from cardiovascular causes. In the case-control study, abnormal P-waves, PTF, interatrial block – and combinations of these P-wave abnormalities with LVH – were associated with cardioembolic IS. Abnormal P-wave and IAB were also associated with cryptogenic IS; and LVH was associated with small-vessel disease (SVD) subtype. In conclusion, ECG in young IS patients provides information on IS etiology, risk of recurrent events, and mortality. P-wave abnormalities and ECG markers of LVH are more frequent in young IS patients than in stroke-free controls, suggesting they may be markers of increased IS risk, which is mostly explained by the HRCE subgroup.

AB - Electrocardiography (ECG) is a routine diagnostic method for all young ischemic stroke (IS) patients, although the relevance of its findings is as yet poorly known. A diagnostic work-up to reveal etiology in a young IS patient includes many cardiac diagnostic methods, as finding a high-risk source of cardioembolism (HRCE) will influence the secondary prevention after IS, and also provides a marker for high risk of recurrent events and mortality. IS per se is a disastrous event, and recurrent cardiovascular events may worsen the situation further. Identifying patients at a high risk of recurrent events is therefore important. The Helsinki Young Stroke Registry (HYSR) includes all 15- to 49-yearold IS patients treated at the Helsinki University Hospital between 1994 and 2007. Blinded to other current clinical data, we analyzed 12-lead resting ECGs obtained 1 to 14 days after IS in 690 patients. We used logistic regression, adjusted for demographic and clinical confounders, to investigate, in 78 patients, what ECG findings are related to an etiology of HRCE (Study I). We investigated what ECG findings bear an increased risk of new cardiovascular events (Study II) and mortality (Study III), using Cox regression adjusted for demographic confounders and comorbidities. We also collected a cohort of stroke-free control subjects in order to study the association of ECG markers with IS at young age, with stratified analysis according to IS subtype (Study IV). Of our IS patient cohort (median age 41 years, 63% male), 35% showed some ECG abnormality. The most common abnormalities were T-wave inversions (16%), left ventricular hypertrophy (LVH) (14%), prolonged P-waves (13%), and prolonged corrected QT interval (QTc) (12%). Of all IS patients, 3% had atrial fibrillation (AF), and 4% P-terminal force in lead V1 (PTF). A longer QRS complex duration, a longer QTc, and wider QRS-T-angle were independently associated with HRCE. Interestingly, PTF had the strongest independent association with HRCE (hazard ratio 43.18). After a median follow-up of 8.8 years, 26.4% of patients experienced some cardiovascular event. 14.6% suffered a recurrent stroke, and 16.1% died; 9.1% died from cardiovascular causes. ECG parameters associated with recurrent cardiovascular events were bundle branch blocks, PTF, LVH, and a broader QRS complex. No ECG parameter was associated with stroke recurrence. A higher heart rate, a shorter P-wave and longer QTc were associated with increased all-cause mortality. Only a higher heart rate was associated with death from cardiovascular causes. In the case-control study, abnormal P-waves, PTF, interatrial block – and combinations of these P-wave abnormalities with LVH – were associated with cardioembolic IS. Abnormal P-wave and IAB were also associated with cryptogenic IS; and LVH was associated with small-vessel disease (SVD) subtype. In conclusion, ECG in young IS patients provides information on IS etiology, risk of recurrent events, and mortality. P-wave abnormalities and ECG markers of LVH are more frequent in young IS patients than in stroke-free controls, suggesting they may be markers of increased IS risk, which is mostly explained by the HRCE subgroup.

KW - Electrocardiography

KW - Stroke

KW - +complications

KW - +mortality

KW - +physiopathology

KW - Brain Ischemia

KW - Young Adult

KW - Heart Rate

KW - Atrial Fibrillation

KW - Interatrial Block

KW - Hypertrophy, Left Ventricular

KW - Embolism

KW - Secondary Prevention

KW - Biomarkers

KW - Cardiovascular Diseases

KW - +epidemiology

KW - Heart Diseases

KW - 3121 Internal medicine

M3 - Doctoral Thesis

SN - 978-951-51-4030-2

PB - [J. Pirinen]

CY - Helsinki

ER -