Abstract 3882: Echocardiographic Associations of Prevalent Stroke in an Elderly Cohort: the Age/Gene Environmental Susceptibility Reykjavik Study (AGES-Reykjavik)
Background: Previous reports have documented the ability of echocardiographic structural parameters to predict incident cerebrovascular disease yet the relative value of these markers has not been assessed.
Methods: We performed a prospective cross-sectional analysis of 627 Icelandic subjects (47% female) over the age of 67 years (mean = 76±6) who underwent both echocardiographic examination and high resolution MRI head scan during the same visit in the AGES-Reykjavik Study, a joint epidemiologic project of the National Institute of Aging and the Icelandic Heart Association. We compared the relationship between historical or silent stroke (llatter determined by high resolution MRI brain scan) and traditional and novel echo measures of cardiac structure and function.
Results: Both crude and height-indexed left atrial (LA) end-systolic volume by Simpson’s modified biplane method (p=0.003 and 0.009 by chi-square) and aortic root dimension (p=0.002) were strongly associated with stroke yet standard (ASE) parasternal LA dimension was not. LA end-systolic area (4 chamber view) had a borderline relationship with stroke (p=0.07). These results remained significant when controlled for atrial fibrillation. There was no relationship between stroke and either crude left ventricular diastolic mass (ASE criteria), mass indexed to height or systolic mass determined by the NIH best slice method. Furthermore, there was no association between stroke and the presence of mitral annular calcification (MAC) or MAC height on two-dimensional point-point measurement or Doppler measures of diastolic function (p=ns for transmitral early/late diastolic velocity ratio (E/A) and mitral medial or lateral peak tissue velocity/early transmitral flow velocity ratio (E/E′). However, transmitral velocity deceleration time trended towards significance (p=0.09).
Conclusion: In this elderly cohort, LA volume and aortic root dimension were strongly associated with historical or MRI-documented silent stroke while other risk factors were not. Whether less robust, traditional echocardiographic stroke predictors are washed out by their high prevalence in this population bears further investigation.