Cardiac dysfunction after acute ischaemic stroke: Long-term outcomes from the SICFAIL cohort

Systolic dysfunction, diastolic dysfunction, and clinically overt heart failure are frequently encountered after acute ischaemic stroke. We investigated whether these cardiac phenotypes, considered as distinct entities, are associated with readmission and death within two years after stroke in the prospective SICFAIL cohort.

Adults with acute ischaemic stroke were consecutively enrolled between 01/2014 and 02/2017. Cardiac function was assessed at baseline, and patients were followed annually by mail or telephone. The primary endpoint was the composite of all-cause readmission or death. Secondary analyses considered individual endpoints and cardiovascular readmissions. Associations were estimated using multivariable Cox proportional hazards models.

Of 696 enrolled patients, 644 (92.5%) had interpretable echocardiographic data. During two-year follow-up, 206 of 554 patients (37.1%) with complete outcome information were rehospitalised, and 63 of 577 patients (11.4%) with available vital status data died. After adjustment, systolic dysfunction and clinically overt heart failure were independently associated with the composite endpoint (systolic dysfunction: hazard ratio [HR] 1.97 (95% confidence interval [CI], 1.34-2.91); clinically overt heart failure: HR 1.62, 95% CI 1.02-2.58). Systolic dysfunction also predicted cardiovascular readmissions (HR 2.27, 95% CI 1.22-4.21). Diastolic dysfunction was not associated with adverse outcomes.

In this cohort, systolic dysfunction and clinically overt heart failure at the time of ischaemic stroke independently predicted the composite of readmission or death over the subsequent two years, whereas isolated diastolic dysfunction was not prognostically informative. Routine echocardiographic assessment after stroke may therefore help identify patients who would benefit from intensified cardiac follow‑up and secondary prevention.