Left ventricular hypertrophy assessed by electrocardiogram is associated with more severe stroke and with higher in-hospital mortality in patients with acute ischemic stroke

Abstract

Background and aimsLeft ventricular hypertrophy (LVH), assessed by electrocardiogram (ECG), is associated with increased risk for stroke. However, few studies that evaluated whether ECG-detected LVH predicts ischemic stroke severity and outcome. We aimed to evaluate these associations. MethodsWe prospectively studied 922 patients consecutively admitted with acute ischemic stroke (age 79.6 ± 6.9 years). Stroke severity was assessed at admission with the National Institutes of Health Stroke Scale (NIHSS). Severe stroke was defined as NIHSS≥5. LVH was evaluated with the Sokolow-Lyon index and the Cornell voltage-duration product criteria in an ECG obtained at admission. The outcome was assessed with dependency at discharge (modified Rankin scale 2–5) and in-hospital mortality. ResultsIndependent predictors of severe stroke were age (relative risk (RR) per year 1.07, 95% confidence interval (CI) 1.03–1.11, p<0.001), female gender (RR 0.36, 95% CI 0.17–0.76, p<0.01), atrial fibrillation (RR 2.07, 95% CI 1.30–3.29, p<0.005), chronic kidney disease (RR 2.38, 95% CI 1.04–5.44, p<0.05), heart rate (RR per 1/min 1.02, 95% CI 1.01–1.04, p<0.005), glucose levels (RR 1.012, 95% CI 1.006–1.018, p<0.001), high-density lipoprotein cholesterol levels (RR 0.976, 95% CI 0.960–0.993, p<0.005) and LVH defined according to the Cornell voltage-duration product criteria (RR 2.08, 95% CI 1.12–3.86, p<0.05). Independent predictors of dependency at discharge were age (RR per year 1.08, 95% CI 1.03–1.13, p<0.001), past smoking (RR versus no smoking 0.42, 95% 0.19–0.89, p<0.05), history of ischemic stroke (RR 2.13, 95% CI 1.23–3.71, p<0.01) and NIHSS at admission (RR 1.48, 95% CI 1.35–1.63, p<0.001). Independent predictors of in-hospital mortality were glucose levels (RR 1.014, 95% CI 1.003–1.025, p<0.05), NIHSS at admission (RR 1.29, 95% CI 1.19–1.41, p<0.001) and LVH according to the Cornell voltage-duration product criteria (RR 4.95, 95% CI 1.09–22.37, p<0.05). ConclusionsLVH according to the Cornell voltage-duration product criteria appears to be associated with more severe stroke and with higher in-hospital mortality in patients with acute ischemic stroke.