Left ventricular non-compaction as a potential source for cryptogenic ischemic stroke in the young : A case-control study

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Pöyhönen , P , Kuusisto , J , Järvinen , V , Pirinen , J , Räty , H , Lehmonen , L , Paakkanen , R , Martinez-Majander , N , Putaala , J & Sinisalo , J 2020 , ' Left ventricular non-compaction as a potential source for cryptogenic ischemic stroke in the young : A case-control study ' , PLoS One , vol. 15 , no. 8 , 0237228 . https://doi.org/10.1371/journal.pone.0237228

Title: Left ventricular non-compaction as a potential source for cryptogenic ischemic stroke in the young : A case-control study
Author: Pöyhönen, Pauli; Kuusisto, Jouni; Järvinen, Vesa; Pirinen, Jani; Räty, Heli; Lehmonen, Lauri; Paakkanen, Riitta; Martinez-Majander, Nicolas; Putaala, Jukka; Sinisalo, Juha
Contributor organization: HUS Heart and Lung Center
Helsinki University Hospital Area
University of Helsinki
HUS Medical Imaging Center
Department of Diagnostics and Therapeutics
HUS Neurocenter
Neurologian yksikkö
Department of Neurosciences
Department of Medicine
Date: 2020-08-14
Language: eng
Number of pages: 13
Belongs to series: PLoS One
ISSN: 1932-6203
DOI: https://doi.org/10.1371/journal.pone.0237228
URI: http://hdl.handle.net/10138/319537
Abstract: Background Up to 50% of ischemic strokes in the young after thorough diagnostic work-up remain cryptogenic or associated with low-risk sources of cardioembolism such as patent foramen ovale (PFO). We studied with cardiac magnetic resonance (CMR) imaging, whether left ventricular (LV) non-compaction-a possible source for embolic stroke due to sluggish blood flow in deep intertrabecular recesses-is associated with cryptogenic strokes in the young. Methods Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome (SECRETO; NCT01934725) is an international prospective multicenter case-control study of young adults (aged 18-49 years) presenting with an imaging-positive first-ever ischemic stroke of undetermined etiology. In this pilot substudy, 30 cases and 30 age- and sex-matched stroke-free controls were examined with CMR. Transcranial Doppler (TCD) bubble test was performed to evaluate the presence and magnitude of right-to-left shunt (RLS). Results There were no significant differences in LV volumes, masses or systolic function between cases and controls; none of the participants had non-compaction cardiomyopathy. Semi-automated assessment of LV non-compaction was highly reproducible. Non-compacted LV mass (median 14.0 [interquartile range 12.6-16.0] g/m(2)vs. 12.7 [10.4-16.6] g/m(2), p = 0.045), the ratio of non-compacted to compacted LV mass (mean 25.6 +/- 4.2% vs. 22.8 +/- 6.0%, p = 0.015) and the percentage of non-compacted LV volume (mean 17.6 +/- 2.9% vs. 15.7 +/- 3.8%, p = 0.004) were higher in cases compared to controls. In a multivariate conditional logistic regression model including non-compacted LV volume, RLS and body mass index, the percentage of non-compacted LV volume (odds ratio [OR] 1.55, 95% confidence interval [CI] 1.10-2.18, p = 0.011) and the presence of RLS (OR 11.94, 95% CI 1.14-124.94, p = 0.038) were independently associated with cryptogenic ischemic stroke. Conclusions LV non-compaction is associated with a heightened risk of cryptogenic ischemic stroke in young adults, independent of concomitant RLS and in the absence of cardiomyopathy.
3121 General medicine, internal medicine and other clinical medicine
3126 Surgery, anesthesiology, intensive care, radiology
Peer reviewed: Yes
Rights: cc_by
Usage restriction: openAccess
Self-archived version: publishedVersion

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