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Karger_ESC London_2013

London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 493 390 Heart and brain Effect of middle cerebral artery territory stroke on QT interval S. Simula1, A.T. Muuronen2, M. Taina3, P. Sipola4, R. Vanninen5, P. Jäkälä6, M. Hedman7 Mikkeli Central Hospital, Department of Neurology, Mikkeli, FINLAND1, Kuopio Universi-ty Hospital and University of Eastern Finland, Institute of Clinical Medicine, Radiology, Kuopio, FINLAND2, Kuopio University Hospital and University of Eastern Finland, Institute of Clinical Medicine, Radiology, Kuopio, FINLAND3, Kuopio University Hospital and University of Eastern Finland, Institute of Clinical Medicine, Radiology, Kuopio, FINLAND4, Kuopio University Hospital and University of Eastern Finland, Institute of Clinical Medicine, Radiology, Kuopio, FINLAND5, Kuopio University Hospital and University of Eastern Finland, Institute of Clinical Medicine, Neu-rology, Kuopio, FINLAND6, Kuopio University Hospital, Heart Center, Kuopio, FINLAND7 Background: Prolonged QT interval associates with increased risk for sudden cardiac death after acute ischemic stroke. However, pathophysiology of prolonged QT interval after stroke is poorly elu-cidated. In this study we investigated whether QT interval dynamics is different in patients with right and left middle cerebral artery (MCA) territory stroke. Methods: Electrocardiogram (ECG) intervals were compared between baseline (retrieved retro-spec- tively from medical records) and admission (acquired at the acute hospital admission) in 33 patients (65+/-9.5years) with right or left MCA territory ischemic stroke. QT intervals were correct-ed for heart rate by Bazett´s formula (QTcBaz), Fridericia formula (QTcFri), Framingham formula (QTcFra) and by Karjalainen approach based on the nomogram adjustment (QTcKar). Head comput-ed tomography (CT), cardiac ultrasound and cardiac CT-scan were undertaken. Results: The stroke was located in the right MCA territory in 21 (64%) and in the left MCA territo-ry in 12 (36%) patients. Patients with right and left MCA stroke were similar with respect to time interval between baseline and admission ECG recording, NIHSS, positive history of heart disease and left ven-tricular dimensions. The increase in QTc from baseline to admission was demonstrated to occur more often in patients with right (16/21;76%) than in patients with left (3/12;25%,p<0.01) MCA stroke. deltaQTcBaz between baseline and admission was significantly longer in patients with right (23+/-23ms) than in patients with left (–11+/-19ms; p<0.0001) MCA stroke. The percentu-al deltaQTcBaz between baseline and admission was correspondingly longer in patients with right (5.5%+/-5.5%) than in patients with left (-2.6+/-4.7%;p<0.001) MCA stroke; results remained com-parbale as QTcFri, QTcFra or QTcKar were applied. Conclusions: Findings suggest cerebral asymmetry in brain-heart interaction during acute ischemic stroke. Right MCA ischemic stroke results in prolongation of QT interval. 391 Heart and brain Right-to-left shunt detection: Is transesophageal echocardiography the gold standard? A.M. Iglesias-Mohedano1, F. Díaz-Otero2, A. García-Pastor3, R. Yotti4, A. Muñoz-González5, P. Sobrino-García6, P. Vázquez-Alen7, Y. Fernández-Bullido8, J.A. Villanueva-Osorio9, A. Gil-Nuñez10 Stroke Unit, Hospital Gregorio Marañón, Madrid, SPAIN1, Stroke Unit, Hospital Gregorio Marañón, Madrid, SPAIN2, Stroke Unit, Hospital Gregorio Marañón, Madrid, SPAIN3, Cardiology Service, Hospital Gregorio Marañón, Madrid, SPAIN4, Stroke Unit, Hospital Gregorio Marañón, Madrid, SPAIN5, Stroke Unit, Hospital Gregorio Marañón, Madrid, SPAIN6, Stroke Unit, Hospital Gregorio Marañón, Madrid, SPAIN7, Stroke Unit, Hospital Gregorio Marañón, Madrid, SPAIN8, Stroke Unit, Hospital Gregorio Marañón, Madrid, SPAIN9, Stroke Unit, Hospital Gregorio Marañón, Madrid, SPAIN10 BACKGROUND: Transesophageal echocardiography (TEE) is considered the gold standard to de-tect patent foramen ovale (PFO), but it has some known limitations. The aim of our study is to com-pare the efficacy between transcranial doppler (TCD), TEE and simultaneous TCD-transthoracic echocardiography (TTE) detecting right-to-left shunt. METHODS: A retrospective study was conducted. Patients diagnosed of migraine or ischemic stroke were included. Right-to-left shunts detected by TCD were compared with TEE results. When results from both techniques were different, a simultaneous TCD-TTE study was performed. The shunt size was classified according to the number of microbubbles detected by TCD. RESULTS: 98 patients were included. In 48 cases (49%), right-to-left shunt was diagnosed by TCD. In 26 of these patients, results from TCD and TEE were compared: A concordance of 76.9% was found between both techniques, but in 6 cases the shunt wasn’t detected by TEE. In 4 of these 6 cas-es, we performed a simultaneous TCD-TTE. All cases were detected by TTE. The Valsalva maneu-ver diagnosed 6 of 20 cases (30%) with TEE and 3 of 4 cases (75%) with TCD-TTE. CONCLUSIONS: TTE and TCD can be more useful than TEE to detect right-to-left shunt, especial-ly when TEE and TCD results are not concordant. This outcome may be related with the better ef-fectiveness of the Valsalva maneuver with TTE or TCD than with TEE. The shunt detection by TTE or TEE was not related with ist magnitude.


Karger_ESC London_2013
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