Journal Article

197 Utility of clinical and structural cardiac parameters in discrimination of cardioembolic and non-cardioembolic stroke subtypes: a systematic review and meta-analysis

Theertham, Anish, Khanna, Shaun, Pius, Piyush, Li, Cindy, Bhat, Aditya

2024

Overview

BackgroundDiscrimination between cardioembolic stroke (CES) and non-CES in undifferentiated stroke subtypes is crucial to guide treatment decisions as these conditions require differing management strategies. In this systematic review and meta-analysis, we sought to identify clinical and structural cardiac parameters associated with clear CES and non-CES subtypes in available stroke populations in the literature.MethodsWe conducted a systematic review of medical databases following PRISMA guidelines, analysing relevant English studies (2000–2023) assessing adult patients with stroke (PROSPERO CRD42023454390) (figure 1). Data was extracted and meta-analysed using a random effects model, with values assessed through an odds ratio (OR) or standardised mean difference (SMD).ResultsTwelve studies were included for analysis, involving a total of 6335 patients. Our meta-analysis showed that CES populations were older (SMD: 0.401, 95% CI: 0.273 to 0.529, p<0.001) with a higher prevalence of heart failure (HF) (OR: 2.528, 95% CI: 1.595 to 4.008, p<0.001). There was no difference in the prevalence of other baseline clinical characteristics. Importantly, CES groups had a significantly lower left ventricular ejection fraction (LVEF) (SMD: -0.430, 95% CI: -0.561 to -0.298, p<0.001) and higher left atrial volume index (LAVI) (SMD: 0.695, 95% CI: 0.556 to 0.834, p<0.001). See table 1.ConclusionBased on available literature, patients with CES tend to be older with more prevalent heart failure, impaired LV function and LA dilatation when compared to non-CES counterparts. Early identification of these parameters in undifferentiated stroke subtypes may aid with further aetiological stroke investigation and subsequent treatment.Abstract 197 Table 1Predictive factors between CES vs non-CES subtypes Outcomes Results 95% CI P-value Age 0.401* 0.273 to 0.529 <0.001 Heart failure 2.528^ 1.595 to 4.008 <0.001 Hypercholesterolemia 0.949^ 0.800 to 1.126 0.551 Diabetes mellitus 0.942^ 0.706 to 1.257 0.686 Coronary artery disease 1.232^ 0.852 to 1.782 0.268 Smoking 0.858^ 0.645 to 1.140 0.291 Mean body mass index -0.0617* -0.220 to 0.0960 0.443 LVEF -0.430* -0.561 to -0.298 <0.001 LAVI 0.695* 0.556 to 0.834 <0.001 ^Odds ratio; *Standardised mean differenceAbstract 197 Figure 1PRISMA flow diagramConflict of InterestNil

• Publisher: BMJ Publishing Group Ltd and British Cardiovascular Society,BMJ Publishing Group LTD
• Subject: Cardioembolic / Cardiovascular disease / Echocardiogram / Heart failure / Imaging / Stroke / Systematic review