PMID- 35354301
OWN - NLM
STAT- MEDLINE
DCOM- 20220629
LR  - 20220804
IS  - 1524-4628 (Electronic)
IS  - 0039-2499 (Linking)
VI  - 53
IP  - 7
DP  - 2022 Jul
TI  - Age Alters Prevalence of Left Atrial Enlargement and Nonstenotic Carotid Plaque 
      in Embolic Stroke of Undetermined Source.
PG  - 2260-2267
LID - 10.1161/STROKEAHA.121.037522 [doi]
AB  - BACKGROUND: Nonstenotic carotid plaque and undetected atrial fibrillation are 
      potential mechanisms of embolic stroke of undetermined source (ESUS), but it is 
      unclear which is more likely to be the contributing stroke mechanism. We explored 
      the relationship between left atrial enlargement (LAE) and nonstenotic carotid 
      plaque across age ranges in an ESUS population. METHODS: A retrospective 
      multicenter cohort of consecutive patients with unilateral, anterior circulation 
      ESUS was queried (2015 to 2021). LAE and plaque thickness were determined by 
      transthoracic echocardiography and computed tomography angiography, respectively. 
      Descriptive statistics were used to compare plaque features in relation to age 
      and left atrial dimensions. RESULTS: Among the 4155 patients screened, 273 (7%) 
      met the inclusion criteria. The median age was 65 years (interquartile range 
      [IQR] 54-74), 133 (48.7%) were female, and the median left atrial diameter was 
      3.5 cm (IQR 3.1-4.1). Patients with any LAE more frequently had hypertension 
      (85.9% versus 67.2%, P<0.01), diabetes (41.0% versus 25.6%, P=0.01), dyslipidemia 
      (56.4% versus 40.0%, P=0.01), and coronary artery disease (22.8% versus 11.3%, 
      P=0.02). Carotid plaque thickness was greater ipsilateral versus contralateral to 
      the stroke hemisphere in the overall cohort (median 1.9 mm [IQR 0-3] versus 1.5 
      mm [IQR 0-2.6], P<0.01); however, this was largely driven by the subgroup of 
      patients without any LAE (median 1.8 mm [IQR 0-2.9] versus 1.5 mm [IQR 0-2.5], 
      P<0.01). Compared with patients >/=70 years, younger patients had more carotid 
      plaque ipsilateral versus contralateral (mean difference 0.42 mm+/-1.24 versus 0.08 
      mm+/-1.54, P=0.047) and less moderate-to-severe LAE (6.3% versus 15.3%, P=0.02). 
      CONCLUSIONS: Younger patients with ESUS had greater prevalence of ipsilateral 
      nonstenotic plaque, while the elderly had more LAE. The differential effect of 
      age on the probability of specific mechanisms underlying ESUS should be 
      considered in future studies.
FAU - Oak, Solomon
AU  - Oak S
AUID- ORCID: 0000-0003-2880-429X
AD  - Cooper Medical School of Rowan University, Camden, NJ (S.O, L.T., N.V., S.K., 
      J.H., P.P.).
FAU - Cucchiara, Brett L
AU  - Cucchiara BL
AUID- ORCID: 0000-0002-5218-9015
AD  - Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia 
      (B.L.C., S.R.-E.).
FAU - Thau, Lauren
AU  - Thau L
AD  - Cooper Medical School of Rowan University, Camden, NJ (S.O, L.T., N.V., S.K., 
      J.H., P.P.).
FAU - Nguyen, Thanh N
AU  - Nguyen TN
AUID- ORCID: 0000-0002-2810-1685
AD  - Department of Neurology, Radiology, Division of Interventional Neuroradiology, 
      Boston Medical Center, MA (T.N.N., A.S., M.A.).
FAU - Sathya, Anvitha
AU  - Sathya A
AUID- ORCID: 0000-0001-8858-7851
AD  - Department of Neurology, Radiology, Division of Interventional Neuroradiology, 
      Boston Medical Center, MA (T.N.N., A.S., M.A.).
FAU - Reyes-Esteves, Sahily
AU  - Reyes-Esteves S
AD  - Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia 
      (B.L.C., S.R.-E.).
FAU - Vigilante, Nicholas
AU  - Vigilante N
AUID- ORCID: 0000-0003-0540-4816
AD  - Cooper Medical School of Rowan University, Camden, NJ (S.O, L.T., N.V., S.K., 
      J.H., P.P.).
FAU - Kamen, Scott
AU  - Kamen S
AUID- ORCID: 0000-0003-4473-9272
AD  - Cooper Medical School of Rowan University, Camden, NJ (S.O, L.T., N.V., S.K., 
      J.H., P.P.).
FAU - Hall, Jillian
AU  - Hall J
AUID- ORCID: 0000-0002-3400-8559
AD  - Cooper Medical School of Rowan University, Camden, NJ (S.O, L.T., N.V., S.K., 
      J.H., P.P.).
FAU - Patel, Parth
AU  - Patel P
AD  - Cooper Medical School of Rowan University, Camden, NJ (S.O, L.T., N.V., S.K., 
      J.H., P.P.).
FAU - Garg, Rahul
AU  - Garg R
AUID- ORCID: 0000-0001-9751-3811
AD  - Department of Neurology, Cooper University Hospital, Camden, NJ (R.G., J.M.T., 
      J.E.S.).
FAU - Abdalkader, Mohamad
AU  - Abdalkader M
AUID- ORCID: 0000-0002-9528-301X
AD  - Department of Neurology, Radiology, Division of Interventional Neuroradiology, 
      Boston Medical Center, MA (T.N.N., A.S., M.A.).
FAU - Thon, Jesse M
AU  - Thon JM
AD  - Department of Neurology, Cooper University Hospital, Camden, NJ (R.G., J.M.T., 
      J.E.S.).
FAU - Siegler, James E
AU  - Siegler JE
AUID- ORCID: 0000-0003-0287-3967
AD  - Department of Neurology, Cooper University Hospital, Camden, NJ (R.G., J.M.T., 
      J.E.S.).
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20220331
PL  - United States
TA  - Stroke
JT  - Stroke
JID - 0235266
SB  - IM
MH  - Aged
MH  - *Atrial Fibrillation/complications/diagnostic imaging/epidemiology
MH  - *Carotid Artery Diseases/complications/diagnostic imaging/epidemiology
MH  - *Embolic Stroke
MH  - Female
MH  - *Heart Defects, Congenital
MH  - Humans
MH  - *Intracranial Embolism/diagnostic imaging/epidemiology
MH  - Male
MH  - *Plaque, Atherosclerotic/complications/diagnostic imaging/epidemiology
MH  - Prevalence
MH  - Risk Factors
MH  - *Stroke/diagnostic imaging/epidemiology
OTO - NOTNLM
OT  - atherosclerotic plaque
OT  - atrial fibrillation
OT  - carotid artery diseases
OT  - cryptogenic stroke
OT  - diabetes
OT  - diagnosis
EDAT- 2022/04/01 06:00
MHDA- 2022/06/30 06:00
CRDT- 2022/03/31 05:03
PHST- 2022/04/01 06:00 [pubmed]
PHST- 2022/06/30 06:00 [medline]
PHST- 2022/03/31 05:03 [entrez]
AID - 10.1161/STROKEAHA.121.037522 [doi]
PST - ppublish
SO  - Stroke. 2022 Jul;53(7):2260-2267. doi: 10.1161/STROKEAHA.121.037522. Epub 2022 
      Mar 31.