title: Revisiting Clinical Utility of Chest Radiography and Electrocardiogram to Determine Ischemic Stroke Subtypes: Special Reference on Vascular Pedicle Width and Maximal P-Wave Duration.
abstract: BACKGROUND
  It is often difficult to diagnose stroke subtypes at admission, particularly in sinus rhythm cases. Vascular pedicle width (VPW) on chest X-ray (CXR) and maximal P-wave duration (P-max) on electrocardiogram (ECG) are again realized as useful parameters reflecting intravascular volume and atrial conduction status, respectively. We investigated the utility of VPW and P-max as a tool for differentiating ischemic stroke subtypes.
  
  
  METHODS
  We studied 343 acute stroke patients showing sinus rhythm on admission. Dividing the patients into cardioembolic (CE) stroke (n = 57) and non-CE (n = 286) groups, we compared clinical backgrounds including VPW on CXR, and P-max in lead II and premature atrial contraction (PAC) on 12-leads ECG. Then, we investigated the independent factors for CE.
  
  
  RESULTS
  Independent factors associated with CE were VPW (≥59.3 mm) (p < 0.001; odds ratio (OR), 10.12; 95% confidence interval (CI), 4.13-24.8), P-max in lead II (≥120 ms) (p < 0.001; OR, 8.61; 95% CI, 3.96-18.7), PAC (p = 0.002; OR, 7.35; 95% CI, 2.14-25.3) and D-dimer level (≥1.11 µg/ml) (p = 0.016; OR, 2.57; 95% CI, 1.20-5.51).
  
  
  CONCLUSIONS
  VPW, P-max, PAC and D-dimer are useful parameters for diagnosing CE stroke in patients with sinus rhythm at admission.
authors.affiliation: Department of Neurology, Showa University Fujigaoka Hospital, Yokohama, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Sugie
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kamiya
authors.forename: Natuko
authors.initials: N
authors.lastname: Iizuka
authors.forename: Hidetomo
authors.initials: H
authors.lastname: Murakami
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Kawamura
authors.forename: Hiroo
authors.initials: H
authors.lastname: Ichikawa
mesh_terms: D000368:Aged; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D020521:Stroke / Q000145:classification* / Q000175:diagnosis*