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ST segment depression detected by continuous electrocardiography in patients with acute ischemic stroke or transient
M M McDermott1, F Lefevre, M Arron
1Division of General Internal Medicine, Northwestern University Medical School, Chicago, Ill.
Insights
ST segment depression, a sign of cardiac issues, affects 29% of acute ischemic stroke or transient ischemic attack (TIA) patients. Left-sided strokes and older age predict its occurrence, suggesting a neurological link.
Area of Science:
- Cardiology
- Neurology
- Clinical Electrocardiography
Background:
- Coronary artery disease (CAD) affects 40% of patients with a history of ischemic stroke or transient ischemic attack (TIA).
- ST segment depression on electrocardiography (ECG) indicates increased cardiac risk in patients with known CAD.
- The cause and significance of ECG changes in acute stroke patients are not well understood.
Purpose of the Study:
- To determine the prevalence of ST segment depression and ventricular arrhythmias in acute ischemic stroke or TIA patients.
- To identify clinical predictors of ST segment depression and ventricular arrhythmias in this population.
Main Methods:
- Continuous electrocardiography (ECG) monitoring for 48 hours in 51 consecutive patients admitted within 72 hours of acute ischemic stroke or TIA.
- Analysis of ECG for ST segment depression and ventricular arrhythmias.
Main Results:
- ST segment depression occurred in 29% of patients (95% CI, 15%–43%).
- Ventricular arrhythmias were observed in 35% of patients (95% CI, 21%–49%).
- Older age and left-sided neurological events were significant predictors of ST segment depression (P < .02 and P < .01, respectively).
Conclusions:
- ST segment depression occurs in 29% of acute ischemic stroke or TIA patients within 5 days post-event, a higher prevalence than in asymptomatic adults.
- The association with left-sided neurological events suggests a potential neurological mediation of these ECG changes.
- Further research is needed to clarify the brain-heart interaction and the role of underlying CAD in ST segment depression among stroke patients.
Background And Purpose:
Forty percent of patients with a history of ischemic stroke or transient ischemic attack (TIA) have concomitant coronary artery disease. ST segment depression, detected by continuous electrocardiography, is associated with increased cardiac morbidity and mortality in patients with known coronary artery disease. While electrocardiographic changes have been associated with acute stroke, the etiology and significance of these changes remain unclear. In this pilot study we report the prevalence of ST segment depression and ventricular arrhythmias in patients with acute ischemic stroke or TIA monitored by continuous electrocardiography. Clinical predictors of ST segment depression and ventricular arrhythmia are also identified.
Methods:
Consecutive patients presenting with acute ischemic stroke or TIA were enrolled within 72 hours of hospital admission and monitored by continuous electrocardiography for 48 hours. The electrocardiographic results were analyzed for periods of ST segment depression and ventricular arrhythmias.
Results:
Of 51 patients with ischemic stroke or TIA, 15 (29%) had episodes of ST segment depression (95% confidence interval, 15% to 43%), and 18 (35%) had ventricular arrhythmias (95% confidence interval, 21% to 49%). In logistic regression analysis, increasing age (P < .02) and a left-sided neurological event (P < .01) were significant predictors of ST segment depression. Increasing numbers of atherosclerotic risk factors, a history of cardiac disease, and increasing or decreasing mean arterial pressure were not predictive of ST segment depression.
Conclusions:
Patients with acute ischemic stroke or TIA have a 29% prevalence of ST segment depression within the first 5 days after their event. In comparison, the prevalence of ST depression is 2.5% to 8% in asymptomatic adults and 43% to 60% in patients with symptomatic coronary artery disease. The association of ST segment depression with left-sided neurological events suggests that the electrocardiographic changes are in part neurologically mediated. Further study is necessary to better define the brain-heart interaction and to determine whether ST segment depression in patients with ischemic stroke or TIA reflects underlying coronary artery disease.