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Resting 12-lead electrocardiogram reveals high-risk sources of cardioembolism in young adult ischemic stroke

Journal article
Authors J. Pirinen
J. Putaala
A. L. Aro
I. Surakka
A. Haapaniemi
M. Kaste
E. Haapaniemi
Turgut Tatlisumak
M. Lehto
Published in International Journal of Cardiology
Volume 198
Pages 196-200
ISSN 0167-5273
Publication year 2015
Published at Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation
Pages 196-200
Language en
Keywords ECG, Stroke, Stroke in the young, PTF, T-wave inversion, Cardioembolism, PROGNOSTIC-SIGNIFICANCE, GENERAL-POPULATION, CLASSIFICATION, MULTICENTER, PREVALENCE, INFARCTION, ECG, Cardiac & Cardiovascular Systems
Subject categories Cardiac and Cardiovascular Systems


Background: The diagnostic work-up to reveal etiology in a young ischemic stroke (IS) patient includes evaluation for high-risk source of cardioembolism (HRCE), since this subtype associates with high early recurrence rate and mortality. We investigated the association of ECG findings with a final etiologic subgroup of HRCE in a cohort of young patients with first-ever IS. Methods: The Helsinki Young Stroke Registry includes IS patients aged 15 to 49 years admitted between 1994 and 2007. Blinded to other clinical data, we analyzed a 12-lead resting ECG obtained 1-14 days after the onset of stroke symptoms in 690 patients. We then compared the ECG findings between a final diagnosis of HRCE (n = 78) and other/undetermined causes (n = 612). We used multivariate logistic regression to study the association between ECG parameters and HRCE. Results: Of our cohort (63% male), 35% showed ECG abnormality, the most common being T-wave inversion (16%), left ventricular hypertrophy (14%), prolonged P-wave (13%), and prolonged QTc (12%). 3% had atrial fibrillation (AF), and 4% P-terminal force (PTF). Of the continuous parameters, longer QRS-duration, QTc, and wider QRS-T-angle independently associated with HRCE. After AF, PTF had the strongest independent association with HRCE (odds ratio = 44.32, 95% confidence interval = [10.51-186.83]), followed by a QRS-T angle > 110 degrees (8.29 [3.55-19.32]), T-wave inversion (5.06, 2.54-10.05), and prolonged QTc (3.02 [1.39-6.56]). Conclusion: Routine ECG provides useful information for directing the work-up of a young IS patient. In addition to AF, PTF in particular showed a strong association with etiology of HRCE. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

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