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Twelve-lead electrocardiogram and mortality in young adults after ischaemic stroke
Jani Pirinen1,2,3, Jukka Putaala2, Karoliina Aarnio2
1Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
Insights
Young stroke patients face higher mortality. Electrocardiogram (ECG) findings like higher heart rate and longer QTc interval predict increased mortality risk in these individuals.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Ischaemic stroke in young adults (<50 years) is associated with increased mortality risk compared to the general population.
- Factors influencing mortality in young stroke survivors are not well understood.
- Electrocardiogram (ECG) parameters may aid in risk stratification for mortality in this demographic.
Purpose of the Study:
- To investigate the association between electrocardiogram (ECG) parameters and mortality risk in young patients following ischaemic stroke.
- To identify specific ECG findings that can predict all-cause and cardiovascular mortality.
Main Methods:
- Analysis of data from the Helsinki Young Stroke Registry, including 690 patients aged <50 years with ischaemic stroke.
- Utilized Cox regression models, adjusted for clinical and demographic factors, to assess ECG parameters against all-cause and cardiovascular mortality endpoints.
- Follow-up duration averaged 8.8 years.
Main Results:
- During follow-up, cumulative all-cause mortality was 16.1% and cardiovascular mortality was 9.1%.
- Higher heart rate, shorter P-wave duration, and longer QTc interval on ECG were associated with increased all-cause mortality.
- Higher heart rate was the only ECG parameter linked to increased cardiovascular mortality.
Conclusions:
- Elevated heart rate in the subacute phase post-stroke is a significant predictor of both all-cause and cardiovascular mortality in young adults.
- A prolonged QTc interval independently predicts higher all-cause mortality in this population.
- Further research is warranted to explore the prognostic value of P-wave characteristics in young stroke survivors.
Introduction:
Ischaemic stroke at young age carries an increased risk for mortality in comparison to the general population, but factors associated with mortality have been poorly studied. We studied the role of electrocardiogram in mortality risk stratification in young stroke patients.
Patients And Methods:
The Helsinki Young Stroke Registry encompasses 1008 patients aged <50 years with ischaemic stroke. We included 690 patients for this electrocardiogram substudy. Our endpoints were all-cause and cardiovascular mortality. Cox regression models - adjusted for clinical and demographic characteristics - were used to identify the electrocardiogram parameters associated with these endpoints.
Results:
At a mean follow-up of 8.8 years, cumulative all-cause and cardiovascular mortality were 16.1 and 9.1%, respectively. Factors associated with both endpoints included diabetes (type 1 for all-cause, type 2 for cardiovascular mortality), heavy drinking, malignancy, as well as stroke severity and aetiology. Of the electrocardiogram parameters, higher heart rate (hazard ratio 1.35 per 10/min, 95% confidence interval 1.21-1.49), a shorter P-wave (hazard ratio 0.78 per 10 ms decrement, 0.64-0.92) and longer QTc interval (1.09 per 10 ms, 1.03-1.16) were associated with increased all-cause mortality. Only a higher heart rate (1.42 per 10/min, 1.24-1.60) was associated with death from cardiovascular causes.
Conclusions:
A higher heart rate during the subacute phase after stroke is associated with an elevated risk of all-cause and cardiovascular mortality in young adults. A longer QTc interval is associated only with higher all-cause mortality. P-wave characteristics and their possible association with mortality need further studies.
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