The P-wave terminal force in embolic strokes of undetermined source.
BACKGROUND
The Embolic Stroke of Undetermined Source (ESUS) is a recently developed clinical construct which describes stroke patients for whom the embolic source remains undetermined despite recommended investigations. The aim of the study was to characterize the ESUS population according to the abnormality in the P-wave terminal force in lead V1(PTFV1).


METHODS
We retrospectively identified consecutive patients hospitalized for acute ischemic stroke who met the ESUS diagnostic criteria. The PTFV1was obtained from the admission 12-lead ECG. Increased PTFV1was defined a value >5000μV·ms. Baseline and diagnostic work-up findings were compared between the PTFV1patient groups.


RESULTS
Among 109 patients with ESUS, 31 (28.4%) had evidence of increased PTFV1. The patients with the ECG-defined left atrial abnormality had higher rates of hypertension (77.4% versus 55.1%; p=0.031), history of prior stroke or TIA (35.5% versus 16.7%; p=0.032), and moderate to severe left atrial enlargement (29.0% versus 7.7%; p=0.004) and ventricular hypertrophy (35.5% versus 16.7%; p=0.032), whereas they were less likely to have patent foramen ovale (9.7% versus 28.2%, p=0.038) and unstable sub-stenotic atherosclerosis of aortic arch and cranial arteries (12.9% versus 32.1%, p=0.041).


CONCLUSIONS
The abnormally increased PTFV1was observed in about one third of patients with ESUS and it was inversely associated with artery-to artery and paradoxical potential sources of stroke. Left atrial cardiopathy could be involved in the ESUS pathogenesis and the ECG-defined abnormality could point towards the risk of cardiac embolism.
Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Via Conca 71, 60020 Ancona, Italy. Electronic address: alfierelattanzisimona@gmail.com.
Simona
S
Lattanzi
Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Via Conca 71, 60020 Ancona, Italy.
Claudia
C
Cagnetti
Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Via Conca 71, 60020 Ancona, Italy.
Alessandra
A
Pulcini
Cardiology Clinic, Marche Polytechnic University, Via Conca 71, 60020 Ancona, Italy.
Marco
M
Morelli
Cardiology Clinic, Marche Polytechnic University, Via Conca 71, 60020 Ancona, Italy.
Simone
S
Maffei
Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Via Conca 71, 60020 Ancona, Italy.
Leandro
L
Provinciali
Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Via Conca 71, 60020 Ancona, Italy.
Mauro
M
Silvestrini
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004562:Electrocardiography; D004617:Embolism / Q000150:complications*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology*
Cerebral ischemia; Cerebrovascular disease; Electrocardiogram; Embolism; Stroke