2018 Volume 67 Issue 5 Pages 668-674
Introduction—There are three types of cerebral infarction, namely, atherothrombotic brain infarction, lacunar infarction, and cardioembolic stroke (CES). In particular, CES has a poor prognosis and needs to be diagnosed early. The detection of atrial fibrillation by electrocardiography is useful for discriminating CES. However, some patients have CES without atrial fibrillation on admission. The aim of this study is to determine the usefulness of electrocardiography for the early discrimination of CES in patients. Method—This study involved 125 patients with cerebral infarction, who had sinus rhythm on admission from April 2014 to May 2015. The types of stroke were divided into two, CES and non-CES (i.e., atherothrombotic brain infarction and lacunar infarction). Results—The subjects were 125 patients (female, 49; male, 76) with acute cerebral infarction and sinus rhythm. The average age was 75.6 ± 12.2 years. Forty-two patients had CES and 83 patients had non-CES. The parameters showing a significant difference between CES and non-CES were P duration (128.0 vs 114.0 ms, p = 0.001), QTc interval (438.0 vs 429.0 ms, p = 0.017), V1P positive potential (60.0 vs 40.0 μV, p = 0.006), BNP (182.0 vs 27.2 pg/mL, p < 0.001), and D-dimer (1.59 vs 0.65 μg/mL, p = 0.001). Multivariate analysis indicated that P duration, V1P positive potential, and BNP are independent predictors for the discrimination of CES. The combination of ECG value and BNP level had a high positive/negative predictive value (95.0% and 93.2%, respectively). Conclusion—We suggest that the combination of electrocardiography and plasma BNP level is useful for the discrimination of cardioembolic stroke.
