Factors predisposing to small lacunar versus large non-lacunar cerebral infarcts: is left ventricular mass involved?

Objectives – To find some specific determinants of lacunar strokes (LS), this study compared LS and non-LS patients using the size and location of cerebral lesions as discriminant between the two groups. Methods – The main cardiovascular risk factors and some echocardiographic parameters were assessed in 225 ischemic stroke patients aged 75.1±11.4 (SD) years, including 101 patients with symptoms and lesions of lacunar type (deep hypodensities with diameter <=1.5 cm) and 124 patients with nonlacunar lesions. Results – LS patients tended to be younger and had a higher prevalence of smokers than non-LS patients. In a subgroup undergoing echocardiogram, those with LS had a higher left ventricular mass index (LVMI) than non-LS patients (141.6±44.9 vs. 115.1±31.8 g/m2, P=0.005). The prevalence of hypertension, diabetes and carotid stenoses >50% was similar in the two groups. In multivariable analysis the ever-smoker status (O.R.=1.9, P=0.02), atrial fibrillation (inverse association, O.R.=0.5, P=0.03), LVMI>=130 g/m2 (O.R.=6.6, P=0.001) and age<=72 years (O.R.=5.9, P=0.003) remained independently associated with LS. Conclusions – The patients with lacunar cerebral lesions had a greater left ventricular mass than those with nonlacunar lesions, while blood pressure values did not differ. Lacunar lesions were also associated with smoking and a younger age.