ECG markers associated with ischemic stroke at young age - a case-control study

• Published in: Annals of medicine (Helsinki) Vol. 49; no. 7; p. 562
• Main Authors: Pirinen, Jani, Eranti, Antti, Knekt, Paul, Lehto, Mika, Martinez-Majander, Nicolas, Aro, Aapo L, Rissanen, Harri, Heliövaara, Markku, Kaste, Markku, Tatlisumak, Turgut, Huikuri, Heikki, Putaala, Jukka
• Format: Journal Article
• Language: English
• Published: England 03.10.2017
• Subjects: Adult; Atrial Fibrillation - diagnosis; Biomarkers; Brain Ischemia - diagnosis; Brain Ischemia - epidemiology; Brain Ischemia - etiology; Case-Control Studies; Electrocardiography; Female; Heart Atria - pathology; Humans; Hypertrophy, Left Ventricular - diagnosis; Male; Middle Aged; Prevalence; Proportional Hazards Models; Risk Factors; Stroke - diagnosis; Stroke - epidemiology; Stroke - etiology; P-wave; left ventricular hypertrophy; case-control study; embolic strokes of undetermined source; Cardioembolism; electrocardiographic; cryptogenic stroke; stroke; stroke in the young
• ISSN: 1365-2060
• DOI: 10.1080/07853890.2017.1348620

Certain electrocardiographic (ECG) abnormalities are associated with ischemic stroke (IS), especially cardioembolic subtype. Besides atrial fibrillation, markers of left ventricular hypertrophy (LVH) or atrial pathology also reflect elevated risk. We studied the association of ECG markers with IS in young adults. We performed a case-control study including 567 consecutive IS patients aged 15-49 years (inclusion period: 1994-2007) and one or two age- and sex-matched control subjects enrolled during 1978-1980 (n = 1033), and investigated also the stroke aetiologic subgroups. We studied ECGs of all participants for markers of atrial abnormality, i.e. P-terminal force (PTF) on lead V1, interatrial blocks (IAB; P-wave duration ≥110 ms), and LVH. Conditional logistic regression analyses were used. IAB (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.16-2.13) and PTF combined with LVH (HR: 6.83, 95% CI: 1.65-28.31), were independently associated with IS. LVH, abnormal P-wave (HR: 6.87, 95% CI: 1.97-135.29), PTF, IAB, and combinations of these P-wave abnormalities with LVH - were associated with cardioembolic subtype. Abnormal P-wave and IAB were associated with cryptogenic stroke subtype. In unadjusted analysis, LVH was associated with small-vessel disease subtype. P-wave abnormalities on ECG were associated with cardioembolic but also with a cryptogenic subtype of IS. Key messages ECG patterns associated with atrial pathology are markers of increased risk of ischemic stroke in young adults. The ECG markers reflecting atrial pathology were seen in patients with cardioembolic and cryptogenic subtypes of ischemic stroke.