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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

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Published on: January 18, 2018

The dispersion of myocardial repolarization in ischemic stroke and intracranial hemorrhage

Alessandra Danese¹, Manuel Cappellari², Elia Pancheri¹

¹Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10 -, 37134 Verona, Italy.

Journal of Electrocardiology

|July 13, 2018

Insights

Electrocardiographic markers of repolarization dispersion, specifically TpTe and TpTe/QTc, were associated with intracranial hemorrhage. Prolonged QT intervals correlated with stroke severity and disability, indicating their potential clinical relevance in cerebrovascular events.

Area of Science:

Cardiology
Neurology
Medical Imaging

Background:

Myocardial repolarization dispersion markers may identify patients at risk of malignant arrhythmias.
The study investigates the association between electrocardiographic (ECG) markers of repolarization dispersion and stroke characteristics.

Purpose of the Study:

To assess the relationship between ECG markers of repolarization dispersion and stroke type (ischemic vs. intracranial hemorrhage).
To evaluate the association with insular involvement, neurological severity (NIHSS), and disability (mRS) in cerebrovascular events.

Main Methods:

Retrospective analysis of prospectively collected data from 63 cerebrovascular event patients.
12-lead ECGs were performed at admission to the Verona Stroke Unit.
Analysis included TpTe, TpTe/QTc in lead V5, and QT max.

Main Results:

TpTe and TpTe/QTc in lead V5 were significantly higher in intracranial hemorrhage compared to ischemic stroke.
QT max was higher in patients with insular involvement.
QTc max correlated with NIHSS at admission; QT max correlated with NIHSS at discharge and mRS at discharge.

Conclusions:

ECG markers TpTe and TpTe/QTc in lead V5 are associated with intracranial hemorrhage.
QT max is associated with insular involvement in stroke patients.
QT interval prolongation correlates with neurological severity and disability post-stroke.

Read full analysis

Abstract

Background:

Markers of dispersion of myocardial repolarization have been proposed to identify the patients at higher risk of malignant arrhythmic events. The aim of the present study is to assess a possible association of the electrocardiografic (ECG) markers of the dispersion of repolarization with the type of stroke, involvement of insula, neurological severity (National Institutes of Health Stroke Scale, NIHSS score), and disability (modified Rankin Scale, mRS score) in patients with a cerebrovascular event.

Methods:

We conducted a retrospective analysis based on data prospectively collected from consecutive patients with a cerebrovascular event who underwent 12‑lead ECG at admission to the Verona Stroke Unit.

Results:

Of the 63 patients included in the study, 55 had ischemic stroke and 8 intracranial hemorrhage. TpTe (time between the peak and the end of the T wave) and TpTe/QTc (TpTe/corrected time between the start of the Q wave and the end of the T wave) in lead V5 were higher in intracranial hemorrhage than in ischemic stroke (p = 0.03 and p = 0.04, respectively) and QT max (the longest QT calculated in the 12 leads) was higher in patients with involvement of insula (p ≤ 0.01). A correlation was found between QTc max and NIHSS score at admission (p = 0.02), QT max and NIHSS score at discharge (p = 0.05), and QT max and mRS score at discharge (p = 0.02).

Conclusions:

TpTe and TpTe/QTc in V5 lead were associated with intracranial hemorrhage and QT max was associated with involvement of insula. The prolongation of QT was correlated with neurological severity and disability.

Keywords:

Cerebrovascular event Miocardial repolarization QT prolongation T-peak to end

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