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An Approach to Working Up Cases of Embolic Stroke of Undetermined Source
BACKGROUND: From a therapeutic viewpoint, it is important to differentiate the underlying causes of embolism in patients with cryptogenic stroke, such as aortic arch atheroma, patent foramen ovale, and paroxysmal atrial fibrillation. We investigated the clinical and radiological characteristics of t...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4943271/ https://www.ncbi.nlm.nih.gov/pubmed/27006118 http://dx.doi.org/10.1161/JAHA.115.002975 |
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author | Ryoo, Sookyung Chung, Jong‐Won Lee, Mi Ji Kim, Suk Jae Lee, Jin Soo Kim, Gyeong‐Moon Chung, Chin‐Sang Lee, Kwang Ho Hong, Ji Man Bang, Oh Young |
author_facet | Ryoo, Sookyung Chung, Jong‐Won Lee, Mi Ji Kim, Suk Jae Lee, Jin Soo Kim, Gyeong‐Moon Chung, Chin‐Sang Lee, Kwang Ho Hong, Ji Man Bang, Oh Young |
author_sort | Ryoo, Sookyung |
collection | PubMed |
description | BACKGROUND: From a therapeutic viewpoint, it is important to differentiate the underlying causes of embolism in patients with cryptogenic stroke, such as aortic arch atheroma, patent foramen ovale, and paroxysmal atrial fibrillation. We investigated the clinical and radiological characteristics of these 3 common causes of cryptogenic embolism to develop models for decision making in etiologic workups. METHODS AND RESULTS: A total of 321 consecutive patients with acute infarcts from cryptogenic embolism were included. Patients were divided into 3 groups—aortic arch atheroma (n=40), patent foramen ovale (n=153), and paroxysmal atrial fibrillation (n=128)—based on extensive cardiologic workups. We used a multinomial logistic regression analysis to detect the clinical and diffusion‐weighted imaging factors associated with the probability of aortic arch atheroma, patent foramen ovale, and paroxysmal atrial fibrillation. Clinical and radiological features differed among the groups. The patent foramen ovale group had a healthy vascular risk factor profile and showed posterior circulation involvement compared with other groups (P<0.01). In contrast, paroxysmal atrial fibrillation–related strokes had higher initial National Institutes of Health Stroke Scale (NIHSS) scores and larger lesions than the other groups (P<0.001). The aortic arch atheroma group had clinical features similar to those of the paroxysmal atrial fibrillation group but showed small lesions scattered in multiple vascular territories (P<0.001). Multivariate regression analysis revealed that age, initial NIHSS score, lesion size (≥20 mm), multiple (≥3) lesions, and involvement of posterior circulation or multiple vascular territories differentiated the 3 groups (pseudo, R (2)=0.656). The prediction ability of this model was validated in the external validation cohort (n=117, area under the curve 0.78). CONCLUSIONS: Our data indicate that patients with cryptogenic embolic stroke show distinct clinical and radiological features depending on the underlying causes. |
format | Online Article Text |
id | pubmed-4943271 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-49432712016-07-20 An Approach to Working Up Cases of Embolic Stroke of Undetermined Source Ryoo, Sookyung Chung, Jong‐Won Lee, Mi Ji Kim, Suk Jae Lee, Jin Soo Kim, Gyeong‐Moon Chung, Chin‐Sang Lee, Kwang Ho Hong, Ji Man Bang, Oh Young J Am Heart Assoc Original Research BACKGROUND: From a therapeutic viewpoint, it is important to differentiate the underlying causes of embolism in patients with cryptogenic stroke, such as aortic arch atheroma, patent foramen ovale, and paroxysmal atrial fibrillation. We investigated the clinical and radiological characteristics of these 3 common causes of cryptogenic embolism to develop models for decision making in etiologic workups. METHODS AND RESULTS: A total of 321 consecutive patients with acute infarcts from cryptogenic embolism were included. Patients were divided into 3 groups—aortic arch atheroma (n=40), patent foramen ovale (n=153), and paroxysmal atrial fibrillation (n=128)—based on extensive cardiologic workups. We used a multinomial logistic regression analysis to detect the clinical and diffusion‐weighted imaging factors associated with the probability of aortic arch atheroma, patent foramen ovale, and paroxysmal atrial fibrillation. Clinical and radiological features differed among the groups. The patent foramen ovale group had a healthy vascular risk factor profile and showed posterior circulation involvement compared with other groups (P<0.01). In contrast, paroxysmal atrial fibrillation–related strokes had higher initial National Institutes of Health Stroke Scale (NIHSS) scores and larger lesions than the other groups (P<0.001). The aortic arch atheroma group had clinical features similar to those of the paroxysmal atrial fibrillation group but showed small lesions scattered in multiple vascular territories (P<0.001). Multivariate regression analysis revealed that age, initial NIHSS score, lesion size (≥20 mm), multiple (≥3) lesions, and involvement of posterior circulation or multiple vascular territories differentiated the 3 groups (pseudo, R (2)=0.656). The prediction ability of this model was validated in the external validation cohort (n=117, area under the curve 0.78). CONCLUSIONS: Our data indicate that patients with cryptogenic embolic stroke show distinct clinical and radiological features depending on the underlying causes. John Wiley and Sons Inc. 2016-03-22 /pmc/articles/PMC4943271/ /pubmed/27006118 http://dx.doi.org/10.1161/JAHA.115.002975 Text en © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial (http://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Original Research Ryoo, Sookyung Chung, Jong‐Won Lee, Mi Ji Kim, Suk Jae Lee, Jin Soo Kim, Gyeong‐Moon Chung, Chin‐Sang Lee, Kwang Ho Hong, Ji Man Bang, Oh Young An Approach to Working Up Cases of Embolic Stroke of Undetermined Source |
title | An Approach to Working Up Cases of Embolic Stroke of Undetermined Source |
title_full | An Approach to Working Up Cases of Embolic Stroke of Undetermined Source |
title_fullStr | An Approach to Working Up Cases of Embolic Stroke of Undetermined Source |
title_full_unstemmed | An Approach to Working Up Cases of Embolic Stroke of Undetermined Source |
title_short | An Approach to Working Up Cases of Embolic Stroke of Undetermined Source |
title_sort | approach to working up cases of embolic stroke of undetermined source |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4943271/ https://www.ncbi.nlm.nih.gov/pubmed/27006118 http://dx.doi.org/10.1161/JAHA.115.002975 |
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