Relations between echocardiography findings and infarct size in patients with ESUS

Introduction
   The aim of this study is to examine the associations between the size of cerebral infarct and echocardiography findings in patients with embolic stroke of undetermined source (ESUS).

Materials and Methods
   This hospital-based study included 42 consecutive patients (mean age 60.8 years; male 71.4%) with ESUS who underwent both transthoracic and transesophageal   echocardiography examinations during hospitalization. We classified the infarct size on MRI into three groups; small infarct was defined as ≤15 mm in size, large infarct as ≥1/3 of the cerebral hemisphere, and medium infarct as intermediate in size between small and large infarcts. Echocardiographic findings were compared between patients with small and medium/large infarcts. 

Results
   Of 42 patients, 22 (52.3%) and 20 (47.6%) had small and medium/large infarct, respectively. Patients with small infarct and medium/large infarct showed significant differences in left atrial appendage flow velocity (57.2 cm/s vs. 70.5 cm/s, P < 0.05). Patients with small infarct more often had left atrial diameter enlargement (>3.8cm) (38.1% vs. 30.0%, P = 0.58) and a high E/e’ ratio (≥15) (26.3% vs. 15.8%, P = 0.42) than those with medium/large infarct. On the other hand, patients with medium/large infarct had complex aortic atheroma (either of ≥4 mm in thickness, ulceration or mobile plaque) more frequently than those with small infarct (37.5% vs. 25.0%, P = 0.62).

Conclusions
In ESUS patients, small infarct was more associated with cardioembolic pathologies, whereas medium/large infarct was related to atherosclerosis.

RELATIONS BETWEEN ECHOCARDIOGRAPHY FINDINGS AND INFARCT SIZE IN PATIENTS WITH ESUS