open access

Vol 14, No 4 (2019)
Review Papers
Published online: 2019-09-06
Get Citation

The role of cardiological diagnostics in cryptogenic stroke — the current state of knowledge

Elwira Bakuła-Ostalska, Janusz Bednarski
DOI: 10.5603/FC.2019.0093
·
Folia Cardiologica 2019;14(4):349-355.

open access

Vol 14, No 4 (2019)
Review Papers
Published online: 2019-09-06

Abstract

Cryptogenic stroke is a stroke of unknown aetiology. Over two thirds of cryptogenic strokes have an embolic, mainly cardio­genic, source. This is why cardiac imaging and looking for cardiac arrhythmia, especially atrial fibrillation, are so important. In patients with implanted devices, the routine use of recording intracardiac electrocardiography in the device’s memory is recommended in order to find so-called atrial high-rate episodes. The improvements in diagnostic tools and the progress in atrial fibrillation monitoring have lowered the number of strokes of unknown aetiology, and in many cases have allowed the application of appropriate secondary prophylaxis.

Abstract

Cryptogenic stroke is a stroke of unknown aetiology. Over two thirds of cryptogenic strokes have an embolic, mainly cardio­genic, source. This is why cardiac imaging and looking for cardiac arrhythmia, especially atrial fibrillation, are so important. In patients with implanted devices, the routine use of recording intracardiac electrocardiography in the device’s memory is recommended in order to find so-called atrial high-rate episodes. The improvements in diagnostic tools and the progress in atrial fibrillation monitoring have lowered the number of strokes of unknown aetiology, and in many cases have allowed the application of appropriate secondary prophylaxis.
Get Citation

Keywords

cryptogenic stroke, embolic strokes of undetermined source, cardiac diagnostics, patent foramen ovale, atrial fibrillation

About this article
Title

The role of cardiological diagnostics in cryptogenic stroke — the current state of knowledge

Journal

Folia Cardiologica

Issue

Vol 14, No 4 (2019)

Pages

349-355

Published online

2019-09-06

DOI

10.5603/FC.2019.0093

Bibliographic record

Folia Cardiologica 2019;14(4):349-355.

Keywords

cryptogenic stroke
embolic strokes of undetermined source
cardiac diagnostics
patent foramen ovale
atrial fibrillation

Authors

Elwira Bakuła-Ostalska
Janusz Bednarski

References (35)
  1. O'Donnell MJ, Xavier D, Liu L, et al. INTERSTROKE investigators. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010; 376(9735): 112–123.
  2. Ay H, Furie KL, Singhal A, et al. An evidence-based causative classification system for acute ischemic stroke. Ann Neurol. 2005; 58(5): 688–697.
  3. Kolominsky-Rabas P, Weber M, Gefeller O, et al. Epidemiology of Ischemic Stroke Subtypes According to TOAST Criteria. Stroke. 2001; 32(12): 2735–2740.
  4. Hart RG, Diener HC, Coutts SB, et al. Cryptogenic Stroke/ESUS International Working Group. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol. 2014; 13(4): 429–438.
  5. Arboix A, Alio J, Arboix A, et al. Cardioembolic stroke: clinical features, specific cardiac disorders and prognosis. Curr Cardiol Rev. 2010; 6(3): 150–161.
  6. Hart RG, Diener HC, Coutts SB, et al. Cryptogenic Stroke/ESUS International Working Group. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol. 2014; 13(4): 429–438.
  7. January C, Wann L, Alpert J, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary. Circulation. 2014; 130(23): 2071–2104.
  8. Sposato LA, Cipriano LE, Saposnik G, et al. Diagnosis of atrial fibrillation after stroke and transient ischemic attack: a systematic review and meta-analysis. Lancet Neurol. 2015; 14(4): 377–387.
  9. Powers WJ, Rabinstein AA, Ackerson T T, et al. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018; 49((3): e46–e110.
  10. Kamel H, Hunter M, Moon Y, et al. Electrocardiographic Left Atrial Abnormality and Risk of Stroke. Stroke. 2015; 46(11): 3208–3212.
  11. Kamel H, Okin PM, Longstreth WT, et al. Atrial cardiopathy: a broadened concept of left atrial thromboembolism beyond atrial fibrillation. Future Cardiol. 2015; 11(3): 323–331.
  12. Dussault C, Toeg H, Nathan M, et al. Electrocardiographic monitoring for detecting atrial fibrillation after ischemic stroke or transient ischemic attack: systematic review and meta-analysis. Circ Arrhythm Electrophysiol. 2015; 8(2): 263–269.
  13. Ricci B, Chang AD, Hemendinger M, et al. A Simple Score That Predicts Paroxysmal Atrial Fibrillation on Outpatient Cardiac Monitoring after Embolic Stroke of Unknown Source. J Stroke Cerebrovasc Dis. 2018; 27(6): 1692–1696.
  14. Montalvo M, Tadi P, Merkler A, et al. PR Interval Prolongation and Cryptogenic Stroke: A Multicenter Retrospective Study. J Stroke Cerebrovasc Dis. 2017; 26(10): 2416–2420.
  15. Schnabel RB, Sullivan LM, Levy D, et al. Development of a risk score for atrial fibrillation (Framingham Heart Study): a community-based cohort study. Lancet. 2009; 373(9665): 739–745.
  16. Lau JK, Lowres N, Neubeck L, et al. iPhone ECG application for community screening to detect silent atrial fibrillation: a novel technology to prevent stroke. Int J Cardiol. 2013; 165(1): 193–194.
  17. Sanna T, Diener HC, Passman R, et al. Cryptogenic Stroke and Underlying Atrial Fibrillation. New England Journal of Medicine. 2014; 370(26): 2478–2486.
  18. Healey JS, Connolly SJ, Gold MR, et al. ASSERT Investigators. Subclinical atrial fibrillation and the risk of stroke. N Engl J Med. 2012; 366(2): 120–129.
  19. Erküner Ö, Rienstra M, Van Gelder IC, et al. Stroke risk in patients with device-detected atrial high-rate episodes. Neth Heart J. 2018; 26(4): 177–181.
  20. Van Gelder IC, Healey JS, Crijns HJ, et al. Duration of device-detected subclinical atrial fibrillation and occurrence of stroke in ASSERT. Eur Heart J. 2017; 38(17): 1339–1344.
  21. William JP, Kent DM, Bulsara KR, et al. American Heart Association Stroke Council. Effect of dysphagia screening strategies on clinical outcomes after stroke: a systematic review for the 2018 Guidelines for the early management of patients with acute ischemic stroke. Stroke. 2018; 49(3): e123–e128.
  22. McGrath ER, Paikin JS, Motlagh B, et al. Transesophageal echocardiography in patients with cryptogenic ischemic stroke: a systematic review. Am Heart J. 2014; 168(5): 706–712.
  23. Longobardo L, Zito C, Carerj S, et al. Role of Echocardiography in Assessment of Cardioembolic Sources: a Strong Diagnostic Resource in Patients with Ischemic Stroke. Curr Cardiol Rep. 2018; 20(12): 136.
  24. Hilberath JN, Oakes DA, Shernan SK, et al. Safety of transesophageal echocardiography. J Am Soc Echocardiogr. 2010; 23(11): 1115–27; quiz 1220.
  25. Mattle HP, Meier B, Nedeltchev K. Prevention of stroke in patients with patent foramen ovale. Int J Stroke. 2010; 5(2): 92–102.
  26. Cotter PE, Martin PJ, Belham M. Patent foramen ovale are more common than previously thought in young patients with strokes. Cerebrovasc Dis. 2010; 29(Suppl. 2): 609.
  27. Monte I, Grasso S, Licciardi S, et al. Head-to-head comparison of real-time three-dimensional transthoracic echocardiography with transthoracic and transesophageal two-dimensional contrast echocardiography for the detection of patent foramen ovale. Eur J Echocardiogr. 2010; 11(3): 245–249.
  28. Fan S, Nagai T, Luo H, et al. Superiority of the combination of blood and agitated saline for routine contrast enhancement. J Am Soc Echocardiogr. 1999; 12(2): 94–98.
  29. Schuchlenz HW, Weihs W, Horner S, et al. The association between the diameter of a patent foramen ovale and the risk of embolic cerebrovascular events. Am J Med. 2000; 109(6): 456–462.
  30. Messé SR, Silverman IE, Kizer JR, et al. Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: recurrent stroke with patent foramen ovale and atrial septal aneurysm: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2004; 62(7): 1042–1050.
  31. Prefasi D, Martínez-Sánchez P, Fuentes B, et al. The utility of the RoPE score in cryptogenic stroke patients ≤50 years in predicting a stroke-related patent foramen ovale. Int J Stroke. 2016; 11(1): NP7–NP8.
  32. Kent DM, Ruthazer R, Weimar C, et al. An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke. Neurology. 2013; 81(7): 619–625.
  33. Lima J, Desai M. Cardiovascular magnetic resonance imaging: Current and emerging applications. Journal of the American College of Cardiology. 2004; 44(6): 1164–1171.
  34. Baher A, Mowla A, Kodali S, et al. Cardiac MRI improves identification of etiology of acute ischemic stroke. Cerebrovasc Dis. 2014; 37(4): 277–284.
  35. Światkiewicz I. „Zastosowanie echokardiografii w diagnostyce i terapii zatorowości sercowopochodnej –wybrane aspekty w świetle zaleceń Europejskiego Towarzystwa Echokardiograficznego”. Folia Cardiologica Excerpta. 2010; 5(6): 339–52.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

 

Wydawcą serwisu jest  "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl