Stroke-Heart Syndrome: Does Sex Matter?

Area of Science:

• Cardiology
• Neurology
• Sex Differences in Medicine

Background:

• Cardiovascular complications after acute ischemic stroke (AIS) arise from comorbid conditions or disruption of the brain-heart axis.
• Women exhibit increased vulnerability to stress-induced cardiac issues like Takotsubo cardiomyopathy.
• Investigating sex-based disparities in cardiac troponin (cTn) elevation, cardiac events, and outcomes post-AIS is crucial.

Purpose of the Study:

• To examine sex differences in cardiac troponin elevation, cardiac events, and mortality following acute ischemic stroke.
• To identify if women are more prone to developing poststroke acute myocardial injury.

Main Methods:

• Retrospective analysis of AIS patients from 5 stroke centers.
• Inclusion criteria: elevated baseline cTn with ≥2 measurements, exclusion of acute comorbid conditions impacting cTn.
• Definition of poststroke acute myocardial injury: dynamic cTn pattern without acute atherosclerotic coronary disease or cardiac death.

Main Results:

• Women (53%) were older, had fewer cardiovascular risk factors, and more cardioembolic strokes with right insula involvement.
• Women showed a higher likelihood of dynamic cTn patterns (aOR 2.1) and poststroke acute myocardial injury (aOR 2.1).
• Poststroke acute myocardial injury correlated with increased 7-day mortality (aOR 5.5).

Conclusions:

• In AIS patients with elevated baseline cTn, women face a doubled risk of poststroke acute myocardial injury.
• This myocardial injury in women is associated with significantly higher short-term mortality.
• Translational research is essential to elucidate the mechanisms behind sex differences in cardiac events and mortality post-AIS.