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Left ventricular myocardial dysfunction in young and middle-aged ischemic stroke patients: the Norwegian stroke in
Sahrai Saeed1, Eva Gerdts1,2, Ulrike Waje-Andreassen3
1Department of Heart Disease, Haukeland University Hospital.
Insights
Hypertension in ischemic stroke patients is linked to reduced global longitudinal strain (GLS), indicating subclinical left ventricular dysfunction. This association persists even after accounting for other risk factors.
Area of Science:
- Cardiology
- Neurology
- Echocardiography
Background:
- Hypertension is common in patients with ischemic stroke.
- The impact of hypertension on subclinical left ventricular (LV) dysfunction in these patients is not well understood.
- Left ventricular myocardial dysfunction can be assessed using echocardiography.
Purpose of the Study:
- To investigate the association between hypertension and subclinical left ventricular (LV) dysfunction in ischemic stroke patients.
- To assess the impact of hypertension on global longitudinal strain (GLS) and global circumferential strain (GCS).
Main Methods:
- 276 ischemic stroke patients (15-60 years) underwent conventional and speckle tracking echocardiography.
- Hypertension was defined by medical history, medication use, or elevated blood pressure measurements.
- Subclinical LV dysfunction was evaluated using peak systolic global longitudinal strain (GLS) and global circumferential strain (GCS).
Main Results:
- 68% of patients had hypertension, associated with higher age, BMI, LV mass, male sex, and diabetes.
- Hypertensive patients showed significantly lower GLS and GCS compared to normotensive patients.
- Reduced GLS remained significantly associated with hypertension after adjusting for confounders, while GCS association was attenuated.
Conclusions:
- In ischemic stroke survivors, hypertension is independently associated with reduced peak systolic global longitudinal strain (GLS).
- This suggests hypertension contributes to subclinical left ventricular dysfunction in ischemic stroke patients.
- The association with global circumferential strain (GCS) was not independent of other factors.
Background:
Hypertension is highly prevalent in ischemic stroke patients, but less is known about its impact on subclinical left ventricular (LV) dysfunction in such patients.
Methods:
Conventional and speckle tracking echocardiography was performed in 276 young (15-44 years) and middle-aged (45-60 years) ischemic stroke patients (mean age 50 ± 9 years, 66% men). Hypertension was defined as a history of hypertension, use of antihypertensive medications, persistently elevated blood pressure (BP) during hospitalization or elevated clinic BP (≥140/90 mmHg) and ambulatory BP (≥130/80 mmHg) at follow-up visits. LV myocardial dysfunction was assessed by peak systolic global longitudinal (GLS) and circumferential strain (GCS).
Results:
Hypertension was present in 68% of patients and associated with higher age, BMI and LV mass, male sex and the presence of diabetes (all P < 0.01). Compared with normotensive patients, hypertensive patients had significantly lower peak systolic GLS (-16 ± 3 vs. -19 ± 2%, P < 0.001) and GCS (-16 ± 3 vs. -18 ± 4%, P < 0.001) while ejection fraction did not differ between groups (P = 0.134). In univariable regression analyses, reduced peak systolic GLS and GCS were both associated with hypertension (β = 0.43 and 0.29, respectively, both P < 0.001). The association with hypertension remained significant for GLS (β = 0.25) after adjustment for LV mass, ejection fraction, male sex, obesity and diabetes (multiple R = 0.35, P < 0.001), whereas the association of hypertension with reduced peak systolic GCS was attenuated.
Conclusion:
In ischemic stroke survivors, hypertension was associated with reduced peak systolic GLS but not GCS independent of confounders.
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