Resting 12-lead electrocardiogram reveals high-risk sources of cardioembolism in young adult ischemic stroke

Int J Cardiol. 2015 Nov 1;198:196-200. doi: 10.1016/j.ijcard.2015.06.095. Epub 2015 Jun 29.


Background: The diagnostic work-up to reveal etiology in a young ischemic stroke (IS) patient includes evaluation for high-risk source of cardioembolism (HRCE), since this subtype associates with high early recurrence rate and mortality. We investigated the association of ECG findings with a final etiologic subgroup of HRCE in a cohort of young patients with first-ever IS.

Methods: The Helsinki Young Stroke Registry includes IS patients aged 15 to 49 years admitted between 1994 and 2007. Blinded to other clinical data, we analyzed a 12-lead resting ECG obtained 1-14 days after the onset of stroke symptoms in 690 patients. We then compared the ECG findings between a final diagnosis of HRCE (n=78) and other/undetermined causes (n=612). We used multivariate logistic regression to study the association between ECG parameters and HRCE.

Results: Of our cohort (63% male), 35% showed ECG abnormality, the most common being T-wave inversion (16%), left ventricular hypertrophy (14%), prolonged P-wave (13%), and prolonged QTc (12%). 3% had atrial fibrillation (AF), and 4% P-terminal force (PTF). Of the continuous parameters, longer QRS-duration, QTc, and wider QRS-T-angle independently associated with HRCE. After AF, PTF had the strongest independent association with HRCE (odds ratio=44.32, 95% confidence interval=[10.51-186.83]), followed by a QRS-T angle >110° (8.29 [3.55-19.32]), T-wave inversion (5.06, 2.54-10.05), and prolonged QTc (3.02 [1.39-6.56]).

Conclusion: Routine ECG provides useful information for directing the work-up of a young IS patient. In addition to AF, PTF in particular showed a strong association with etiology of HRCE.

Keywords: Cardioembolism; ECG; PTF; Stroke; Stroke in the young; T-wave inversion.

MeSH terms

  • Adolescent
  • Adult
  • Brain Ischemia / diagnosis*
  • Brain Ischemia / epidemiology
  • Brain Ischemia / physiopathology
  • Cohort Studies
  • Electrocardiography / instrumentation
  • Electrocardiography / methods*
  • Embolism / diagnosis*
  • Embolism / epidemiology
  • Embolism / physiopathology
  • Female
  • Heart Diseases / diagnosis*
  • Heart Diseases / epidemiology
  • Heart Diseases / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Registries
  • Retrospective Studies
  • Risk Factors
  • Stroke / diagnosis*
  • Stroke / epidemiology
  • Stroke / physiopathology
  • Young Adult