Evaluation of p-wave Dispersion and Left Atrium Ejection Fraction in Patients with Cardioembolic Ischemic Stroke

Authors

DOI:

https://doi.org/10.33448/rsd-v10i6.15301

Keywords:

Stroke; p-wave; Atrial function.

Abstract

Introduction: Studies show that p-wave dispersion and left atrial ejection fraction are predictors of cardiovascular events. Purpose: To verify the association of p-wave dispersion and left atrial ejection fraction with cardioembolic ischemic stroke. Methods: This is an observational, cross-sectional, case-control study with 61 patients, mean age of 65.6, with sinus rhythm ischemic stroke who underwent clinical evaluation with CHA2DS2-VASc score, electrocardiogram, echocardiogram and ultrasonography with Doppler of both carotid and vertebral arteries. The groups were divided into cardioembolic (cases) and non-cardioembolic (controls). The p-wave dispersion was obtained with a 12-lead electrocardiographic tracing at 50 mm/s by subtracting the largest p-wave by the smallest one. Left atrial ejection fraction was obtained using the modified biplane Simpson method. This study was approved by the UERN Research Ethics Committee (# 2,536,483). Results: Mean values for p-wave dispersion were 62.5 ms for cases and 49 ms for controls (p = 0.025). For left atrial ejection fraction, the cases presented a mean of 42.9% and the controls a mean of 55.8% (p = 0.003). For the CHA2DS2-VASc score, the mean values were 3.6 and 3.1 for cases and controls, respectively (p = 0.35). Cardiovascular risk factors showed similar distribution in both groups. Conclusion: p-wave dispersion and left atrial ejection fraction were associated with the cardioembolic patients with sinus rhythm that have gone through ischemic stroke.

References

Acampa, M., Guideri, F., Tassi, R., Buono, D. D., Celli, L., & Mammarella, L. T., et al. (2015). P wave dispersion on cryptogenic stroke: A risk factor for cardioembolism? Internal Journal of Cardiology, 190, 202-204. 10.1016/j.ijcard.2015.04.185.

Adams Jr., H. P., Bendixen B. H., Kappelle, L. J., Biller, J., Love, B. B., Gordon, D. L., & Marsh, E. E. (1993). Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke, 24, 35-41. 10.1161/01.str.24.1.35.

Arboix, A., & Alió, J. (2010). Cardioemboic Stroke: Clinical Features, Specific Cardiac Disorders and Prognosis. Current Cardiology Reviews, 6, 150-161. 10.2174/157340310791658730.

Baturova, M. A., Sheldon, S. H., Carlson, J., Brady, P. A., Lin, G., Rabinstein, A. A., et al. (2016). Eletrocardiographic and Echocardiographic predictors of paroxysmal atril fibrillation detected after ischemic stroke. BMC Cardiovascular Disorders, 16(1), 209-217. 10.1186/s12872-016-0384-2.

Beggs, S. A. S., Rorth, R., Gardner, R. S., & McMurray, J. J. V. (2019) Anticoagulation therapy in heart failure and sinus rhythm: a systematic review and meta-analysis. Heart, 105 (17), 1325-1334. 10.1136/heartjnl-2018-314381.

Biller, J., Love, B. B., & Schneck, M. J. (2008). Vascular Diseases of the Nervous System – Ischemic Cerebrovascular Disease. In Bradley, W.G., Daroff, R.B., Fenichel, G.M., Jankovic, J. (Eds.) Neurology in Clinical Pratice. (pp. 1165-1212). London: Elsevier Health Sciences.

Caplan, L.R. (1995). Clinical diagnosis of brain embolism. Cerebrovasc Dis. 5, 79-88. https://doi.org/10.1159/000315468.

Chalela, J.A., Kidwell, C. S., Nentwich, L. M., Luby, M., Butman, J. A., Demchuk, A. M., et al. (2007). Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet. 369 (9558), 293–298. 10.1016/S0140-6736(07)60151-2.

Dilaveris, P. E., & Gialafos, J. E. (2001). P-Wave Dispersion: A Novel Predictor of Paroxysmal Atrial Fibrillation. Ann Noninvasive Electocardiol,, 6 (2), 159-165. 10.1111/j.1542-474x.2001.tb00101.x.

Dogan, U., Dogan, E.A., Tekinalp, M., Tokgoz, O.S., Aribas, A., Akilli, H., et al. (2012). P-wave Dispersion for Predicting Paroxysmal Atrial Fibrillation in Acute Ischemic Stroke. Internal Journal of Medical Sciences, 9 (1), 108-114. 10.7150/ijms.9.108.

Field, A. (2009). Descobrindo a Estatística usando o SPSS. (2a ed.). Artmed.

Hart, R. G. (1992). Cardiogenic embolism to the brain. Lancet, 339, 589- 94. 10.1016/0140-6736(92)90873-2.

Healey, J. S., Connolly, S. J., Gold, M. R., Israel, C. W., van Gelder, I. C., Capucci, A., et al. (2012). Subclinical Atrial Fibrillation and the Risk of Stroke. N Engl J Med. 366, 120-129. 10.1056/NEJMoa1105575.

Hohnloser, S. H., Capucci, A., Fain, E., Gold, M. R., van Gelder, I. C., Healey, J., et al. (2006). Asymptomatic atrial fibrillation and Stroke Evaluation in pacemaker patients and the atrial fibrillation Reduction atrial pacing Trial (ASSERT). American Heart Journal, 152, 442-447. 10.1016/j.ahj.2006.02.016.

January, C. T., Wann, L. S., Calkins, H., Chen, L.Y., Cigarroa, J. E., Cleveland Jr., J. C., et al. (2019). 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2019; 140 (2), e125-e151. 10.1016/j.jacc.2019.01.011.

Krishnamurthi, R. V., Feigin, V. L., Forouzanfar, M. H., Mensah, G. A., Bennett, D. A., Moran, A. E., et al. (2013). Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: findings from the Global Burden of Disease Study. Lancet Glob Health, 1 (5), e259-e281. 10.1016/S2214-109X(13)70089-5.

Lang, R. N., Badano, R. P., Mor-Avi, V., Afialo, J., Armstrong, A., Ernade, L., et al. (2015). Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography, 28 (1), 1-53. 10.1016/j.echo.2014.10.003.

Magalhães, L. P., Figueiredo, M. J. O., Cintra, F. D., Saad, E. B., Kuniyoshi, R. R., Teixeira, R. A., et al. (2016). II Diretrizes Brasileiras de Fibrilação Atrial. Arq Bras Cardiol. 106 (4), 1-22. http://publicacoes.cardiol.br/2014/diretrizes/2016/02_II%20DIRETRIZ_FIBRILACAO_ATRIAL.pdf.

Murray, C. J., Lopez, A. D., & Jamison, D. T. (1994). The global burden of disease in 1990: summary results, sensitivity analysis and future directions. Bull World Health Organ, 72, 495–509. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2486716/.

Naghavi, M., Wang, H., Lozani, R., Davis, A., Liang, X., Zhou, M., et al. (2015). Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet, 2015; 385, 117–71. 10.1016/S0140-6736(14)61682-2.

Rasmussen, S. M. A., Olsen, F. J., Jǿrgensen, P. G., Fritz-Hansen, T., Jespersen, T., Gislason, G., et al. (2019). Utility of left atrial strain for predicting atrial fibrillation following ischemic stroke. Int J Cardiovasc Imaging, 35 (9), 1605-1613. 10.1007/s10554-019-01601-0.

Sacco, R. L., Kasner, S. E., Broderick, J. P., Caplan, L. R., Connors, J. J., Culebras, A., et al. (2013). American Heart Association Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Council on Cardiovascular Radiology and Intervention, Council on Cardiovascular and Stroke Nursing, Council on Epidemiology and Prevention, Council on Peripheral Vascular Disease, Council on Nutrition, Physical Activity and Metabolism. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 44 (7), 2064–2089. 10.1161/STR.0b013e318296aeca.

Tenekecioglu, E., Agca, F. V., Ozluk, O. A., Karaagac, K., Demir, S., Peker, T., et al. (2014). Função Atrial Esquerda Prejudicada Associada com a Fibrilação Atrial Paroxística na Hipertensão. Arq Bras Cardiol. 102 (3), 253-262. https://doi.org/10.5935/abc.20140009.

Wolf, P. A., Abbott, R. D., Kannel, W. B. (1991). Atrial Fibrillation as an Independent Risk Factor for Stroke: The Framingham Study. Stroke, 22, 983-988. 10.1161/01.str.22.8.983.

Yoon, J. H., Moon, J., Chung, H., Choi, E. Y., Kim, J. Y., Min, P., et al. (2013). Left atrial function assessedby Doppler echocardiography rather than left atrial volume predict recurrence in patients with paroxysmal atrial fibrillation. Clin Cardiol, 36 (4), 235-40. 10.1002/clc.22105.

Zannad, F., Anker, S.D., Byra, W. M., Cleland, J. G. F., Fu, M., Gheorghiade, M., et al. (2018). COMMANDER HF Investigators. Rivaroxaban in Patients with Heart Failure, Sinus Rhythm, and Coronary Disease. N Engl J Med, 379, 1332-1342. 10.1056/NEJMoa1808848.

Downloads

Published

19/05/2021

How to Cite

VÉRAS, F. H. A. P. .; AZEVEDO, E. P. de .; LUCENA, E. E. de S. .; PINHEIRO, F. I. .; PAIVA, J. R. L. de .; BARISIC JÚNIOR, S.; GUZEN, F. P. Evaluation of p-wave Dispersion and Left Atrium Ejection Fraction in Patients with Cardioembolic Ischemic Stroke. Research, Society and Development, [S. l.], v. 10, n. 6, p. e2810615301, 2021. DOI: 10.33448/rsd-v10i6.15301. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/15301. Acesso em: 18 jun. 2021.

Issue

Section

Health Sciences