P6389Arterial stiffness and indices of diastolic heart failure as predictors of ischemic strokes of undetermined etiology

Abstract

Background: Approximately 1.1 million inhabitants of Europe suffer from a stroke each year, and ischemic stroke accounts for approximately 80% of all cases. A substantial proportion of stroke risk remains unexplained. Identification of the prognostic factors is essential in order to prepare an adequate preventive strategy. Purpose: The study aimed to identify echocardiographic and circulating biomark-ers as well as hemodynamic indices of ischemic strokes of undetermined etiology (ESUS) in patients at age<65. Methods: We prospectivelyinvestigated 520 patients with confirmed ischemic stroke. Out of them we included 65 patients to ESUS group [age 54 (47-58) years, 42% males].36 patients without stroke were control group [age 53 (47-58) years, 61% males]. All patients underwent echocardiography non-invasive assessment of hemodynamic parameters using SphygmoCor tonometer (Atcor Med., Australia), as well as measurements of selected biomarkers and lipids. Results: There were no differences in peripheral systolic and diastolic blood pres-sure as well as in leftventricular ejection fraction (LVEF) between ESUS and control group. ESUS patients had lower mean early diastolic (E') [p=0,0008] and systolic (S') mitral annularvelocity [p=0,03] and higher E/E' ratio compared to control group [p=0,0002]. The peak velocity flow in late diastole-A wave value and LV mass indexed to body surface area (LVMI) (g/m$sup$2$/sup$) were higher in ESUS group than in control [p=0,01 and p=0,0004, respectively]. Isovolumetric relaxation time (IVRT) was longer in ESUS patients compared to control group [p=0,001]. Mean left atrial volume index (LAVI) was higher in ESUS group [p=0,01]. The parameters of arterial stiffness: augmentation pressure (AP), augmentation index (AIx) and augmentation index adjusted to a heart rate of 75 bpm (AIx75) were higher in ESUS patients compared to control [p=0,001 and p=0,03, and p=0,009 respectively]. Highe density lipoprotein (HDL)cholesterol level was significantly lower in ESUS group than in controls [p=0,02]. Patients in ESUS group had higher levels of asymmetric dimethylarginine ([p=0,0002), interleukin 6 (p=0,002) and N-terminal pro-brain natriuretic peptide (NT-proBNP) (p=0,003) than the control group. In the multivariate analysis the following factors were significantly asso-ciated with the presence of ESUS: Alx75 (odds ratio [OR] 1.095, 95%Cl 1.004-1.194; p=0.04), IVRT (OR 1.045, 95% CI: 1.009-1.082; p=0.014), LAVI (OR 1.3, 95% CI: 1.099-1.537; p=0.002) (Figure 1) and NT-proBNP (OR 1.003, 95% CI 1.001-1.005; p=0.005) (Figure 2). [Figure Presented] Conclusions: The increased arterial stiffness and indices of diastolic heart failure are associated independently with the occurrenceof ischemic strokes of undetermined etiology. Funding Acknowledgements: research grant no. 502-03/5-139-02/502-54-203 of the Polish Ministry of Science and Higher Education and Medical University of Lodz.