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[Acute cerebrovascular accident and heart disease. Prospective study of 248 patients]
A S Franco1, J Monteiro, P Cortes
1Servico de Medicina I e Núcleo de Estudos de Hipertensão Arterial, Hospital de Santa Maria (HSM), Faculdade de Medicina de Lisboa, FML.
Insights
Heart disease is common in stroke patients, affecting 81%. Identifying cardiac sources of embolus (CPE) and hypertension is crucial for preventing strokes and improving outcomes.
Area of Science:
- Cardiology
- Neurology
- Internal Medicine
Context:
- Stroke is a leading cause of disability and mortality.
- Understanding the interplay between heart disease and stroke is vital for effective management.
- Cerebrovascular disease encompasses various subtypes, each potentially linked to different cardiac pathologies.
Purpose:
- To investigate the association between different types and subtypes of cerebrovascular disease and co-existing heart conditions.
- To identify potential cardiac sources of embolus (CPE) in acute stroke patients.
- To assess the prevalence of hypertension and specific cardiac abnormalities in relation to stroke type.
Summary:
- A prospective study of 248 acute stroke patients revealed significant heart disease prevalence (81%).
- Hypertension and hypertensive cardiopathy were more common in intracerebral hemorrhage (HI), while atrial fibrillation (FA) was more frequent in ischemic stroke (AI), particularly cortical AI.
- Cardiac sources of embolus (CPE), including FA, were identified in 34% of patients, highlighting their importance in embolic stroke prevention.
Impact:
- The findings underscore the critical importance of diagnosing heart disease in stroke patients for prophylaxis and prognosis.
- Echocardiography (ECO) proves valuable in identifying CPE, especially in elderly patients.
- This research aids in tailoring stroke prevention strategies by linking specific cardiac conditions to stroke subtypes.
Objective:
To evaluate the heart disease associated to different type and sub-types of cerebrovascular disease with particular reference to potential cardiac sources of embolus (CPE).
Design:
Prospective study in 248 consecutive patients with acute stroke, admitted to a Clinical Medicine Unit in three independent time periods.
Setting:
Internal Medicine Clinic of University Hospital in Lisbon.
Methods:
Neurologic and cardiologic examination were performed and all patients were also submitted to different complementary tests, including a Computer Tomography Scan of the brain (TAC) and a Echocardiogram (ECO). We identified two types and two sub-types: intracerebral haemorrhage (HI) or ischemic stroke (AI) and among AI, cortical (C) or subcortical (SC) ischemic stroke. For each type and sub-type we evaluated past history, heart disease, hypertension (HTA), electrocardiogram, echocardiogram (ECO) and CPE.
Patients:
Two hundred and forty eight patients (52% were men) with mean age 68.0 +/- 10.2 years and ages between 40 and 92 years. Thirty seven (15%) died.
Main Results:
Eighty four percent were AI and among them 45% were C. Previous strokes were more prevalent in AI 29% (p < 0.01). There was heart disease in 81% and hypertensive cardiopathy was more frequent in HI 63% (p < 0.002). HTA and atrial fibrillation (FA) were more frequent in HI 83% (p < 0.05) and in AI 25% (p < 0.004) respectively. ECO showed a dilatation of left atrium more frequent in AI 28% (p < 0.05) and left ventricular concentric hypertrophy index (IHCE) in HI 50% (p < 0.05). CPE, including FA, was identified in 34% of patients, was more prevalent in AI 38% (p < 0.001) and among it FA was significantly more frequent in C 32% (p < 0.02).
Conclusions:
Heart disease is very frequent in stroke. The diagnosis of this condition is very important for stroke prophylaxis and prognosis. HTA and hypertensive cardiopathy have a great prevalence and were more related to HI. CPE and FA were very frequent and their diagnosis are important for prevention of AI and specially for embolic stroke. ECO is useful to identify CPE in elderly patient in particular to characterize heart disease.