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Stress Hyperglycemia Ratio Is Associated with Intracardiac Thrombus in Acute Ischemic Stroke

Vedat Cicek1, Almina Erdem2, Ezgi Hasret Kozan Çıkırıkçı3

  • 1Department of Radiology, Machine and Hybrid Intelligence Lab, Northwestern University, Chicago, IL, United States; Tatvan State Hospital, Bitlis, Türkiye.

Turk Kardiyoloji Dernegi Arsivi : Turk Kardiyoloji Derneginin Yayin Organidir
|April 20, 2026
PubMed

Insights

The stress hyperglycemia ratio (SHR) is linked to hidden intracardiac thrombi in acute ischemic stroke (AIS) patients. This finding may improve risk assessment and guide the use of transesophageal echocardiography (TEE).

Area of Science:

  • Cardiology
  • Neurology
  • Biomarker Research

Background:

  • Transthoracic echocardiography (TTE) is standard for cardiac evaluation in acute ischemic stroke (AIS) but can miss intracardiac thrombi.
  • Transesophageal echocardiography (TEE) detects thrombi missed by TTE.
  • Stress hyperglycemia ratio (SHR) is a novel cardiovascular biomarker, but its role in detecting TTE-undetected intracardiac thrombi in AIS is unknown.

Purpose of the Study:

  • To investigate the association between SHR and intracardiac thrombus in AIS patients.
  • To determine if SHR can identify thrombi missed by TTE but detected by TEE.
  • To evaluate SHR's potential in risk stratification for AIS patients.

Main Methods:

  • Retrospective study of 486 AIS patients with negative TTE but positive TEE findings.
  • Analysis of demographic, laboratory, and echocardiographic data.
  • Logistic regression and ROC analysis to assess independent associations with intracardiac thrombus.

Main Results:

  • TEE detected intracardiac thrombus in 13.2% of patients.
  • Patients with thrombus had significantly higher SHR, CRP, and creatinine, and lower ejection fraction.
  • SHR was independently associated with intracardiac thrombus (OR=2.39, P=0.027) after multivariable adjustment.

Conclusions:

  • SHR is significantly associated with intracardiac thrombus missed by TTE in AIS patients.
  • SHR may serve as a valuable biomarker for identifying patients who could benefit from TEE.
  • Elevated SHR could aid in refining risk stratification and guiding the selective use of TEE in AIS.
Abstract

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