Arterial Hypertension and Its Consequences Are the Main Predictors of Embolic Stroke of Undetermined Source

Abstract

Background and Purpose. Embolic stroke of undetermined source (ESUS) is a subcategory of cryptogenic stroke with high frequency of occurrence and insufficient understanding its risk factors leads to the lack of determined strategies for primary/secondary prevention. This study was aimed to identify the most prominent predictors of the ESUS and to generate the overall predictive model. Methods. We performed a hospital-based prospective cohort study with 1,317 enrolled participants. We compared patients and healthy volunteers according to the main demographic, anthropometric parameters, stroke risk factors, comorbidities, and data of clinical and instrumental examination. In order to balance the study and the control groups for age and sex, the propensity score matching was performed. In order to generate the overall predictive model, a multivariate analysis was performed using the binary logistic regression method. Results. The following predictors of ESUS were identified in current study: arterial hypertension (AH); increased heart rate and pulmonary arterial systolic pressure (PASP); the presence of conduction disturbance; the enlargement of left, right atrium, and left ventricle end-systolic length; increased intima–media thickness (IMT) in right and left common carotid artery (CCA); lowered Montreal Cognitive Assessment (MoСA) cognitive scale score; the presence of subcortical microbleeds; central brain atrophy; the larger size of third ventricle; and the higher medial temporal lobe atrophy (MTA) score. The following risk factors were included in the final predictive model: the presence of AH ( $p<0.0005$ ; OR = 12.98 (95% CI: 4.53–37.21)) and PASP ( $p=0.018$ ; OR = 1.13 (95% CI: 1.02–1.25)) and male sex ( $p=0.046$ ; OR = 2.771 (95% CI: 1.017–7.555)). The Nagelkerke’s pseudo-R-squared value was 0.404 and the significance of the Hosmer–Lemeshow test was 0.733, which indicate the goodness of the final logistic regression model. Conclusions. We propose that AH and its consequences are the main predictors of ESUS. The results of this study emphasize the importance of AH control for primary and secondary prevention of ESUS.