Structural-electrical remodeling of myocardium in neurological deficits in patients with ischemic stroke: is there a connection?

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Theoretical and clinical questions of the correlation between structural-electrical remodeling of the heart and the severity of neurological deficits at stroke have not been developed or remain controversial so far. Available data in the literature suggests the key role of structural myocardial disorders mainly in hemorrhagic stroke, and cardiocerebral syndrome is considered only from the standpoint of cardioembolic stroke. The aim of the study. To study the peculiarities of structural-electrical remodeling of myocardium with severity of neurological deficit in patients with ischemic stroke. Materials and methods. 111 patients with ischemic stroke in the left hemisphere and 75 patients in the right brain hemisphere were examined. The average age was 56.7 ± 5.58 years. All subjects underwent an ultrasound examination of the heart using the ALOKA SSD 5000 apparatus (Japan) and the QT dispersion using the Polyspectro-8EX apparatus (Russia). Duration of QT dispersion interval more than 50 ms was considered pathological. Research results. Structural remodeling of the heart in patients with ischemic stroke was manifested by the prevalence of high values of the finite-systolic volume of the left ventricle in comparison with patients without stroke (45.8 ± 21.0 vs. 37.7 ± 16.9 ml; p < 0.05), and the finite-diastolic volume of the left ventricle (114.3 ± 38.5 vs. 100.9 ± 35.3 ml; p < 0.05), mainly in the right hemispheric localization of the stroke. Hypertrophy of the ventricular septum (11.3 ± 2.1 and 11.1 ± 2.2) and the posterior wall of the left ventricle (10.4 ± 1.8 and 10.3 ± 2.1 mm) was observed irrespective of the localization of the stroke, which was higher in comparison with patients without stroke (9.4 ± 1.5 mm). Violations of repolarization processes and their severity were characterized by higher values of duration of the corrected QT interval in patients with structural changes of myocardium in comparison with the patients without structural remodeling (0,46 ± 0,03 and 0,44 ± 0,02 sec; p = 0,025). The conjugation of the severity of the neurological deficit (7 and more points on the NIHSS scale) was associated with the terminal-systolic size of the LV (p = 0.025) and myocardial hypertrophy (11.3 ± 1.86 vs. 10.96 ± 1.8 mm; p = 0.04) in comparison with patients with a neurological deficit of less than 7 points (31.7 ± 3.6 vs. 30.68 ± 3.86 mm; p < 0.025). The severity of the neurological deficit according to the Goldstein criteria correlated with higher values of the corrected (56.0 ± 23.93 vs. 41.6 ± 23.3 ms.; p = 0.043) and normalized QT (17.5 ± 6.533 vs. 12.8 ± 6.7 ms.; p = 0.019) values in comparison with the lower neurological deficit. A similar relationship was revealed by the Brott criteria. Conclusions. Thus, the direct connection between structural-electrical remodeling of the heart and neurological deficit revealed in the course of the study reflects the cardiocerebral relationships in ischemic stroke.