CARDIAC CHANGES IN ACUTE ISCHEMIC STROKE

Maria Mirabela Manea,Vladimir Moldoveanu,Sorin Tuta,Constantin Popa,Dorin Dragos

doi:10.37897/rjn.2017.1.3

Abstract

Purpose: the analysis of the paraclinical features of heart changes in the acute ischemic stroke, especially electrocardiographic (ECG) abnormalities. Material and methods. We performed a prospective study on 23 patients admitted in our stroke unit with large lesions induced by acute ischemic strokes and no history of cardiovascular disease. Results. The average age of patients was 72,87 +/- 11,55 years. On admission NIHSS score was higher in the cardioembolic stroke patients compared to atherothrombotic stroke patients, the difference persisting after the first seven days. Echocardiography demonstrated a larger left atrium area in cardioembolic compared to atherothrombotic stroke patients. The E-wave deceleration time (a diastolic function parameter) was longer in atherothrombotic compared to cardioembolic stroke. The ECG monitoring and repeated 24h Holter monitoring detected atrial fibrillation (AF) in 52, 17% of the patients and it was associated with a higher in-hospital mortality and stroke severity. No significant correlation was found between the increase in troponin T levels and AF, or in-hospital mortality. Discusions. In our study atherothrombotic stroke is associated with a more pronounced tendency to diastolic dysfunction compared to cardioembolic stroke. The percentage of detected AF is higher than expected because of: 1) the higher average age of patients, 2) the inclusion of patients with large strokes, and 3) continuous ECG and Holter monitoring for longer periods of time compared to the usual procedure in stroke patients. Conclusion. The cardiologic monitoring has strong implications for stroke mechanisms and short and long term outcome and prognosis of the patients.

Highlights

Cardiogenic embolism accounts for up to 30% of all ischemic strokes [1]
Classical opinion is that atrial fibrillation (AF) is a frequent cause of cerebral embolism, sometimes AF may be the consequence of neurogenic injury [4]
Transthoracic echocardiographic exam may reveal cardiac anomalies associated with an increased risk for embolism: such as cardiac myxoma, cardiomyopathies, anomalies of the mitral valve apparatus, left atrial dilation, sustaining that AF is the primary cause of the stroke [6]

Summary

Introduction

Cardiogenic embolism accounts for up to 30% of all ischemic strokes [1]. The prevalence of atrial fibrillation (AF) among the patients with ischemic stroke varies between 15% and 38% [2], but in some higher risk subgroups it can be detected in more than 50% of patients [3]. The purpose of this small study was the analysis of the paraclinical features of heart changes in the acute ischemic stroke, especially ECG abnormalities in a subset of patients with large ischemic cerebral lesions selected from the stroke unit of our hospital.

Results

Conclusion