title: Resting 12-lead electrocardiogram reveals high-risk sources of cardioembolism in young adult ischemic stroke.
abstract: 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° (8.29 [3.55-19.32]), T-wave inversion (5.06, 2.54-10.05), and prolonged QTc (3.02 [1.39-6.56]).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland. Electronic address: jani.pirinen@helsinki.fi.
authors.forename: Jani
authors.initials: J
authors.lastname: Pirinen
authors.affiliation: Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland.
authors.forename: Jukka
authors.initials: J
authors.lastname: Putaala
authors.affiliation: Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Aapo L
authors.initials: AL
authors.lastname: Aro
authors.affiliation: Institute for Molecular Medicine Finland FIMM, University of Helsinki, Finland.
authors.forename: Ida
authors.initials: I
authors.lastname: Surakka
authors.affiliation: Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland; University of Eastern Finland, Faculty of Medicine, Finland.
authors.forename: Anita
authors.initials: A
authors.lastname: Haapaniemi
authors.affiliation: Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland.
authors.forename: Markku
authors.initials: M
authors.lastname: Kaste
authors.affiliation: Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland.
authors.forename: Elena
authors.initials: E
authors.lastname: Haapaniemi
authors.affiliation: Department of Neurology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Turgut
authors.initials: T
authors.lastname: Tatlisumak
authors.affiliation: Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Mika
authors.initials: M
authors.lastname: Lehto
mesh_terms: D000293:Adolescent; D000328:Adult; D002545:Brain Ischemia / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D015331:Cohort Studies; D004562:Electrocardiography / Q000295:instrumentation / Q000379:methods*; D004617:Embolism / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D055815:Young Adult
keywords: Cardioembolism; ECG; PTF; Stroke; Stroke in the young; T-wave inversion