Sex Differences in Cardiac Rhythm and Conduction Abnormalities After Noncardioembolic Ischemic Stroke

Cardiac pathologies can occur after acute ischemic stroke (AIS) even in patients without prior heart disease, reflecting bidirectional brain-heart interactions. We investigated sex-specific differences in newly diagnosed cardiac pathologies within 1 year after noncardioembolic AIS.

We screened 7113 patients with a first cerebrovascular event (December 2013 to March 2021) at a tertiary stroke center and included 673 patients (39% women, aged 61.2 years) with noncardioembolic AIS and no evidence of previous cardiac disease. After AIS, all patients received standard cardiologic evaluation (24-hour in-hospital telemetry, 24-hour blood pressure monitoring, echocardiography, and 48-hour Holter ECG). Electronic health records were reviewed for cardiology consultations and testing within 1 year after the index event (eg, ECG, echocardiography, coronary computed tomographic angiography, cardiac magnetic resonance imaging, myocardial perfusion single-photon emission computed tomography). Multivariable binary logistic regression models were adjusted for age, antihypertensive and lipid-lowering therapy, hypertension, diabetes, hyperlipidemia, and smoking.

Compared with women, men more frequently exhibited nonsustained ventricular tachycardia (odds ratio, 3.97 [95% CI, 1.14-13.86]; P=0.031), first-degree atrioventricular block (odds ratio, 5.71 [95% CI, 1.48-22.01]; P=0.013), bradycardia (odds ratio, 3.40 [95% CI, 1.50-7.67]; P=0.003), and polymorphic ventricular extrasystoles (odds ratio, 2.61 [95% CI, 1.43-4.74]; P=0.002) within 1 year after AIS. Findings were consistent after multivariable adjustment.

In this single-center cohort of patients without known heart disease and noncardioembolic AIS, poststroke cardiac findings were more common in men, particularly nonsustained ventricular tachycardia and polymorphic ventricular extrasystoles. These hypothesis-generating observations support further investigation into sex-informed poststroke cardiac evaluation.