Clinical and Neuroimaging Characteristics in Embolic Stroke of Undetermined versus Cardioembolic Origin

A Population-Based Study

Georgios Tsivgoulis, Odysseas Kargiotis, Aristeidis H. Katsanos, Athanasia Patousi, Maria Pikilidou, Theodosis Birbilis, Michael Mantatzis, Lina Palaiodimou, Sokratis Triantafyllou, Nikolaos Papanas, Panagiotis Skendros, Aikaterini Terzoudi, George S. Georgiadis, Efstratios Maltezos, Charitomeni Piperidou, Aspasia Serdari, Aikaterini Theodorou, Ignatios Ikonomidis, Ioannis Heliopoulos, Konstantinos Vadikolias

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND PURPOSE: Evidence suggests that cardioembolism represents the underlying mechanism in the minority of embolic strokes of undetermined source (ESUS). In this population-based study, we sought to compare the clinical and imaging characteristics as well as outcomes in patients with ESUS and cardioembolic stroke (CE). METHODS: We included consecutive patients with first-ever ischemic stroke (IS) from the previously published population-based Evros-Stroke-Registry identified as ESUS or CE according to standardized criteria. Baseline characteristics, admission NIHSS scores, cerebral edema, hemorrhagic transformation, stroke recurrence, functional outcomes (determined by modified Rankin Scale [mRS] scores), and mortality rates were recorded during the 1-year follow-up period. RESULTS: We identified 21 ESUS (3.7% of IS) and 211 CE (37.1% of IS) cases. Patients with ESUS were younger (median age: 68 years [interquartile range [IQR]: 61-75] vs 80 years [IQR: 75-84]; P <.001), had lower median admission NIHSS scores (4 points [IQR: 2-8] vs 10 points [IQR: 5-17]; P <.001), and lower prevalence of cerebral edema on neuroimaging studies (0 vs. 33.3%, P =.002). Functional outcomes were more favorable in ESUS at 28 (median mRS score: 2 [IQR: 1-3] vs 4 [IQR: 4-5]; P <.001), 90 (median mRS score: 1 [IQR: 0-2] vs 4 [IQR: 3-5]; P <.001), and 365 days (median mRS score: 1 [IQR: 0-2] vs 4 [IQR: 2-4]; P < 0.001). At 1-year, the mortality rate was lower in ESUS (0% [95% confidence interval [CI]: 0-13.5%] vs 34.6% [95% CI: 28.2-41.0%]; P <.001); the 1-year recurrent rate was also lower numerically (0% [95% CI: 0-13.5%] vs 9.5% [95% CI: 5.5-13.4%]; P =.140) but this difference failed to reach statistical significance due to the small study population. CONCLUSIONS: The clinical and neuroimaging profiles as well as clinical outcomes vary substantially between ESUS and CE indicating different underlying mechanisms.

Original languageEnglish (US)
JournalJournal of Neuroimaging
DOIs
StateAccepted/In press - Jan 1 2019

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Neuroimaging
Atrial Fibrillation
Stroke
Population
Confidence Intervals
Brain Edema
Mortality
Registries

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

Clinical and Neuroimaging Characteristics in Embolic Stroke of Undetermined versus Cardioembolic Origin : A Population-Based Study. / Tsivgoulis, Georgios; Kargiotis, Odysseas; Katsanos, Aristeidis H.; Patousi, Athanasia; Pikilidou, Maria; Birbilis, Theodosis; Mantatzis, Michael; Palaiodimou, Lina; Triantafyllou, Sokratis; Papanas, Nikolaos; Skendros, Panagiotis; Terzoudi, Aikaterini; Georgiadis, George S.; Maltezos, Efstratios; Piperidou, Charitomeni; Serdari, Aspasia; Theodorou, Aikaterini; Ikonomidis, Ignatios; Heliopoulos, Ioannis; Vadikolias, Konstantinos.

In: Journal of Neuroimaging, 01.01.2019.

Research output: Contribution to journalArticle

Tsivgoulis, G, Kargiotis, O, Katsanos, AH, Patousi, A, Pikilidou, M, Birbilis, T, Mantatzis, M, Palaiodimou, L, Triantafyllou, S, Papanas, N, Skendros, P, Terzoudi, A, Georgiadis, GS, Maltezos, E, Piperidou, C, Serdari, A, Theodorou, A, Ikonomidis, I, Heliopoulos, I & Vadikolias, K 2019, 'Clinical and Neuroimaging Characteristics in Embolic Stroke of Undetermined versus Cardioembolic Origin: A Population-Based Study', Journal of Neuroimaging. https://doi.org/10.1111/jon.12660
Tsivgoulis, Georgios ; Kargiotis, Odysseas ; Katsanos, Aristeidis H. ; Patousi, Athanasia ; Pikilidou, Maria ; Birbilis, Theodosis ; Mantatzis, Michael ; Palaiodimou, Lina ; Triantafyllou, Sokratis ; Papanas, Nikolaos ; Skendros, Panagiotis ; Terzoudi, Aikaterini ; Georgiadis, George S. ; Maltezos, Efstratios ; Piperidou, Charitomeni ; Serdari, Aspasia ; Theodorou, Aikaterini ; Ikonomidis, Ignatios ; Heliopoulos, Ioannis ; Vadikolias, Konstantinos. / Clinical and Neuroimaging Characteristics in Embolic Stroke of Undetermined versus Cardioembolic Origin : A Population-Based Study. In: Journal of Neuroimaging. 2019.
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title = "Clinical and Neuroimaging Characteristics in Embolic Stroke of Undetermined versus Cardioembolic Origin: A Population-Based Study",
abstract = "BACKGROUND AND PURPOSE: Evidence suggests that cardioembolism represents the underlying mechanism in the minority of embolic strokes of undetermined source (ESUS). In this population-based study, we sought to compare the clinical and imaging characteristics as well as outcomes in patients with ESUS and cardioembolic stroke (CE). METHODS: We included consecutive patients with first-ever ischemic stroke (IS) from the previously published population-based Evros-Stroke-Registry identified as ESUS or CE according to standardized criteria. Baseline characteristics, admission NIHSS scores, cerebral edema, hemorrhagic transformation, stroke recurrence, functional outcomes (determined by modified Rankin Scale [mRS] scores), and mortality rates were recorded during the 1-year follow-up period. RESULTS: We identified 21 ESUS (3.7{\%} of IS) and 211 CE (37.1{\%} of IS) cases. Patients with ESUS were younger (median age: 68 years [interquartile range [IQR]: 61-75] vs 80 years [IQR: 75-84]; P <.001), had lower median admission NIHSS scores (4 points [IQR: 2-8] vs 10 points [IQR: 5-17]; P <.001), and lower prevalence of cerebral edema on neuroimaging studies (0 vs. 33.3{\%}, P =.002). Functional outcomes were more favorable in ESUS at 28 (median mRS score: 2 [IQR: 1-3] vs 4 [IQR: 4-5]; P <.001), 90 (median mRS score: 1 [IQR: 0-2] vs 4 [IQR: 3-5]; P <.001), and 365 days (median mRS score: 1 [IQR: 0-2] vs 4 [IQR: 2-4]; P < 0.001). At 1-year, the mortality rate was lower in ESUS (0{\%} [95{\%} confidence interval [CI]: 0-13.5{\%}] vs 34.6{\%} [95{\%} CI: 28.2-41.0{\%}]; P <.001); the 1-year recurrent rate was also lower numerically (0{\%} [95{\%} CI: 0-13.5{\%}] vs 9.5{\%} [95{\%} CI: 5.5-13.4{\%}]; P =.140) but this difference failed to reach statistical significance due to the small study population. CONCLUSIONS: The clinical and neuroimaging profiles as well as clinical outcomes vary substantially between ESUS and CE indicating different underlying mechanisms.",
author = "Georgios Tsivgoulis and Odysseas Kargiotis and Katsanos, {Aristeidis H.} and Athanasia Patousi and Maria Pikilidou and Theodosis Birbilis and Michael Mantatzis and Lina Palaiodimou and Sokratis Triantafyllou and Nikolaos Papanas and Panagiotis Skendros and Aikaterini Terzoudi and Georgiadis, {George S.} and Efstratios Maltezos and Charitomeni Piperidou and Aspasia Serdari and Aikaterini Theodorou and Ignatios Ikonomidis and Ioannis Heliopoulos and Konstantinos Vadikolias",
year = "2019",
month = "1",
day = "1",
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TY - JOUR

T1 - Clinical and Neuroimaging Characteristics in Embolic Stroke of Undetermined versus Cardioembolic Origin

T2 - A Population-Based Study

AU - Tsivgoulis, Georgios

AU - Kargiotis, Odysseas

AU - Katsanos, Aristeidis H.

AU - Patousi, Athanasia

AU - Pikilidou, Maria

AU - Birbilis, Theodosis

AU - Mantatzis, Michael

AU - Palaiodimou, Lina

AU - Triantafyllou, Sokratis

AU - Papanas, Nikolaos

AU - Skendros, Panagiotis

AU - Terzoudi, Aikaterini

AU - Georgiadis, George S.

AU - Maltezos, Efstratios

AU - Piperidou, Charitomeni

AU - Serdari, Aspasia

AU - Theodorou, Aikaterini

AU - Ikonomidis, Ignatios

AU - Heliopoulos, Ioannis

AU - Vadikolias, Konstantinos

PY - 2019/1/1

Y1 - 2019/1/1

N2 - BACKGROUND AND PURPOSE: Evidence suggests that cardioembolism represents the underlying mechanism in the minority of embolic strokes of undetermined source (ESUS). In this population-based study, we sought to compare the clinical and imaging characteristics as well as outcomes in patients with ESUS and cardioembolic stroke (CE). METHODS: We included consecutive patients with first-ever ischemic stroke (IS) from the previously published population-based Evros-Stroke-Registry identified as ESUS or CE according to standardized criteria. Baseline characteristics, admission NIHSS scores, cerebral edema, hemorrhagic transformation, stroke recurrence, functional outcomes (determined by modified Rankin Scale [mRS] scores), and mortality rates were recorded during the 1-year follow-up period. RESULTS: We identified 21 ESUS (3.7% of IS) and 211 CE (37.1% of IS) cases. Patients with ESUS were younger (median age: 68 years [interquartile range [IQR]: 61-75] vs 80 years [IQR: 75-84]; P <.001), had lower median admission NIHSS scores (4 points [IQR: 2-8] vs 10 points [IQR: 5-17]; P <.001), and lower prevalence of cerebral edema on neuroimaging studies (0 vs. 33.3%, P =.002). Functional outcomes were more favorable in ESUS at 28 (median mRS score: 2 [IQR: 1-3] vs 4 [IQR: 4-5]; P <.001), 90 (median mRS score: 1 [IQR: 0-2] vs 4 [IQR: 3-5]; P <.001), and 365 days (median mRS score: 1 [IQR: 0-2] vs 4 [IQR: 2-4]; P < 0.001). At 1-year, the mortality rate was lower in ESUS (0% [95% confidence interval [CI]: 0-13.5%] vs 34.6% [95% CI: 28.2-41.0%]; P <.001); the 1-year recurrent rate was also lower numerically (0% [95% CI: 0-13.5%] vs 9.5% [95% CI: 5.5-13.4%]; P =.140) but this difference failed to reach statistical significance due to the small study population. CONCLUSIONS: The clinical and neuroimaging profiles as well as clinical outcomes vary substantially between ESUS and CE indicating different underlying mechanisms.

AB - BACKGROUND AND PURPOSE: Evidence suggests that cardioembolism represents the underlying mechanism in the minority of embolic strokes of undetermined source (ESUS). In this population-based study, we sought to compare the clinical and imaging characteristics as well as outcomes in patients with ESUS and cardioembolic stroke (CE). METHODS: We included consecutive patients with first-ever ischemic stroke (IS) from the previously published population-based Evros-Stroke-Registry identified as ESUS or CE according to standardized criteria. Baseline characteristics, admission NIHSS scores, cerebral edema, hemorrhagic transformation, stroke recurrence, functional outcomes (determined by modified Rankin Scale [mRS] scores), and mortality rates were recorded during the 1-year follow-up period. RESULTS: We identified 21 ESUS (3.7% of IS) and 211 CE (37.1% of IS) cases. Patients with ESUS were younger (median age: 68 years [interquartile range [IQR]: 61-75] vs 80 years [IQR: 75-84]; P <.001), had lower median admission NIHSS scores (4 points [IQR: 2-8] vs 10 points [IQR: 5-17]; P <.001), and lower prevalence of cerebral edema on neuroimaging studies (0 vs. 33.3%, P =.002). Functional outcomes were more favorable in ESUS at 28 (median mRS score: 2 [IQR: 1-3] vs 4 [IQR: 4-5]; P <.001), 90 (median mRS score: 1 [IQR: 0-2] vs 4 [IQR: 3-5]; P <.001), and 365 days (median mRS score: 1 [IQR: 0-2] vs 4 [IQR: 2-4]; P < 0.001). At 1-year, the mortality rate was lower in ESUS (0% [95% confidence interval [CI]: 0-13.5%] vs 34.6% [95% CI: 28.2-41.0%]; P <.001); the 1-year recurrent rate was also lower numerically (0% [95% CI: 0-13.5%] vs 9.5% [95% CI: 5.5-13.4%]; P =.140) but this difference failed to reach statistical significance due to the small study population. CONCLUSIONS: The clinical and neuroimaging profiles as well as clinical outcomes vary substantially between ESUS and CE indicating different underlying mechanisms.

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