Comparison of ECG findings between young patients with cryptogenic ischemic stroke and stroke-free control subjects

Background Cryptogenic ischemic strokes (CIS) in young adults have increased globally, and in up to half of these cases, no clear cause can be identified. The significance of ECG findings in these patients is unknown. Therefore we investigated ECGs findings of patients with CIS compared to healthy controls. Methods In this sub-study of the international multicenter SECRETO study, a standard 12-lead ECG was obtained from 18–49-year-old CIS patients and stroke-free controls. Here, we included 508 patients and 453 controls with ECG of sufficient quality for central reading. We assessed P duration, P-wave terminal force in V1 (PTF), number of biphasic P-waves in the inferior leads, QRS duration, heart rate, rAVL and criteria for left ventricular hypertrophy, ventricular conduction abnormalities, T-wave abnormalities and automatic ECG interpretation statement. Results Compared to controls CIS patients showed longer QRS duration (96ms vs 94ms, p=0.036), higher heart rate (65bpm vs 63bpm,p=0.006) and RaVL amplitude (0.46mV vs 0.38mV, p<0.001). Furthermore, abnormality in conduction or T-wave (53 vs 26, p=0.024) and in the automatic ECG interpretation (164 vs 103, p=0.001) were more frequent in patients. Contrary, PTF was longer in controls (1.8mV·ms vs 2.3mV·ms p<0.001) and more frequently over 4mV·ms (49 vs 78 p=0.001). Discussion: Our ECG findings suggest that subtle cardiac pathology not related to atrial cardiopathy is one of the drivers of CIS in young adults, promoting thorough cardiac work-up in these patients.