Abstract TP572: Electrocardiogram T Wave Abnormalities are Associated With the Total Burden of Cerebral Small Vessel Disease in Patients With Acute Ischemic Stroke or Transient Ischemic Attack

Abstract

Introduction: Electrocardiogram (ECG) abnormalities are commonly seen in patients with acute ischemic stroke (AIS). We aimed to determine the influence of the underlying brain state as measured by the total cerebral small vessel disease (CSVD) burden on ECG abnormalities in patients with AIS or Transient Ischemic Attack (TIA). Methods: Patients with AIS and TIA were prospectively enrolled in a hospital-based stroke registry. Total CSVD burden was measured according to Staals et al on the first brain MRI obtained within 48 hours from hospital admission. Stroke volume was measured on the DWI sequences using ABC/2 formula according to Sims et al. ECG abnormalities were noted on the first ECG obtained in the Emergency Department. Additionally, PR and QTC intervals and QRS complex duration were measured. Univariate analysis was used to test the relationships between total CSVD burden and ECG abnormalities. Linear regression and binary logistic regression models were used for the variables that were significant in univariate analysis to adjust for age, sex, race, current smoking, history of atrial fibrillation, coronary artery disease, valvular disease, myocardial infarction, hypertension, diabetes, hyperlipidemia, antihypertensive medications, stroke volume and involvement of the insula by the stroke. Results: 141 patients (age 64.5±15.3, 49% females, total CSVD burden was 1.6±1.4, stroke volume 21±40.6, heart rate 79.6±16.5, PR interval 168.4±27 ms, QRS complex 94.1±19.2 ms, QTC interval 450±37.1 ms, abnormalities of ST, T wave, right ventricular hypertrophy, left ventricular hypertrophy, bundle branch block and myocardial infarction were seen in 19.8%, 26.5%, 1.7%, 9.2%, 6.7% and 24.2%). Rhythm was sinus in 72.7% and atrial fibrillation in 8.6%. In univariate analysis, there was significant relationship of total CSVD score with QTC interval and T wave abnormalities (P values: 0.01 and 0.0036 respectively). The relationship of T wave abnormality with total CSVD burden remained significant in logistic regression analysis (OR: 2.2, 95% CI: 1-4.8, P: 0.05). Conclusions: Total CSVD burden is associated with ECG T wave abnormalities in TIA and AIS patients. Further research is required to identify the underlying pathophysiological mechanisms.