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Cardiac Findings Following Cerebrovascular Disease
Marco H Rohner1, Catherine Gebhard2, Andreas Luft1,3
1Department of Neurology University Hospital Zurich and University of Zurich Zurich Switzerland.
Insights
Cardiac findings are common after stroke, even without prior heart issues. Electrocardiogram changes were most frequent in ischemic stroke patients, highlighting the need for cardiac evaluation after any cerebrovascular event.
Area of Science:
- Neurology
- Cardiology
- Neurocardiology
Background:
- Cardiac complications are an understudied aspect of brain-heart interactions following stroke.
- Understanding cardiac manifestations across different cerebrovascular events is crucial.
Purpose of the Study:
- To investigate and compare cardiac findings in patients experiencing acute ischemic stroke, transient ischemic attack, and hemorrhagic stroke.
- To assess the frequency and types of cardiac abnormalities post-cerebrovascular events.
Main Methods:
- Retrospective analysis of 721 patients with ischemic stroke, transient ischemic attack, or hemorrhagic stroke treated between 2013-2020.
- Screening of clinical reports for new cardiac findings (arrhythmia, myocardial alterations, valvular abnormalities, coronary perfusion insufficiency) within one year of the event.
- Statistical comparison of cardiac findings across different cerebrovascular event types using Pearson chi-squared or Fisher exact tests.
Main Results:
- Electrocardiogram (ECG) changes were observed in 81.7% of ischemic stroke, 71.4% of transient ischemic attack, and 55.8% of hemorrhagic stroke patients (P<0.001).
- Myocardial alterations were frequent across all groups: 60.9% in ischemic stroke, 59.2% in transient ischemic attack, and 44.2% in hemorrhagic stroke (P=0.396).
- Significant differences in ECG changes were noted among the groups, with ischemic stroke showing the highest prevalence.
Conclusions:
- Cardiac findings are prevalent in patients with cerebrovascular disease, irrespective of pre-existing cardiac conditions or suspected cardioembolic origin.
- Similar cardiac manifestation patterns were observed between ischemic stroke and transient ischemic attack patients.
- A comprehensive cardiac workup is recommended for all patients presenting with acute cerebrovascular events to detect potential cardiac complications.
Background:
Accumulating evidence suggests that cardiac findings after stroke are an important, yet understudied, manifestation of brain-heart interactions. Our aim was to investigate and compare cardiac findings after different cerebrovascular events (acute ischemic stroke, transient ischemic attack, and hemorrhagic stroke).
Methods And Results:
There were 7113 patients screened who were treated between December 2013 and December 2020 at the University Hospital Zurich for ischemic stroke, transient ischemic attack, and hemorrhagic stroke. Seven hundred twenty-one patients without evidence of previous cardiac disease or presumed cardioembolic origin of their cerebrovascular disease and with at least 1 cardiac checkup were included. Clinical reports from the year following disease onset were screened for new cardiac findings, which were categorized as arrhythmia/electrocardiographic changes, myocardial alterations, valvular abnormalities, and coronary perfusion insufficiency. Differences in proportions of findings among groups were analyzed using the Pearson χ2 test or Fisher exact test. ECG changes were observed in 81.7% (n=474) of patients with ischemic stroke, 71.4% (n=70) of patients with transient ischemic attack, and 55.8% (n=24) of patients with hemorrhagic stroke (P<0.001). Myocardial alterations occurred often in all 3 groups (60.9% ischemic stroke [n=353], 59.2% transient ischemic attack [n=58], 44.2% hemorrhagic stroke [n=19]; P=0.396).
Conclusions:
Cardiac findings are frequent in patients with cerebrovascular disease, even without prior cardiac problems or suspected cardiac cause. Similarities, especially between patients with ischemic stroke and transient ischemic attack, were observed. Our data suggest that all patients with acute cerebrovascular events should receive thorough workup searching for cardiac manifestations.
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