Abstract P83: Diagnostic Implication of D-dimer Level in Cardioembolic Stroke
[Background] Acute ischemic stroke is an etiologically heterogenous disease and its therapeutic strategy varies in each subtype, such as cardioembolic stroke. Although rapid diagnosis of ischemic stroke subtypes in emergency room (ER) could be of importance, precise diagnostic algorithm has yet been established.
[Methods] Sixty-one patients with acute ischemic stroke (<24 hours from symptom onset) brought to ER in our institute by ambulance were retrospectively analyzed. Of these, 14 patients with active inflammatory, malignant, and aortic disease were excluded. The remaining 47 patients were classified into cardioembolic stroke (C group) and stroke with non-cardiac origin (non-C group) according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria based on clinical and brain imaging, 12-lead ECG, transthoratic and/or transesophageal echocardiography findings, and physical and blood examination findings were each analyzed.
[Results] Of the 47 patents, 23 patients were classified into C group (15 cases with persistent atrial fibrillation, 5 with paroxyxmal atrial fibrillation, and 3 with heart failure with low cardiac function) and the remaining 24 patients into non-C group. Mean age was 81±3 years old in C group, which was significantly higher than in non-C group (67±3 years old, p<0.01). Systolic blood pressure was slightly lower and heart rate was slightly higher in C-group. Blood chemistry tests showed markedly higher D-dimer level in C group (3.75±0.90 ig/ml) than in non-C group (1.01±0.17 ig/ml, p<0.01 vs C group), though no significant differences in white blood cell count, eGFR, and CRP level. Multivariate logistic-regression analysis revealed D-dimer level as an independent predictor for cardioem-bolic stroke (adjusted odds ratio=2.80, 95% CI: 1.16 – 6.75, p<0.05). D-dimer level of 1.15 ig/ml was selected as a cutoff value by using receiver operating characteristic analysis curve, resulted in a sensitivity of 70.6% and specificity of 61.1% (p<0.05).
[Conclusions] D-dimer level is a possible independent predictor for acute diagnosis of cardioembolic stroke and may lead to an aggressive therapeutic strategy in ER for acute ischemic stroke.