Ejection fraction response of the left ventricle of the heart to acute cerebrovascular accident in patients with coronary artery disease.

Abstract

SUMMARYThe ejection fraction (EF) of the left ventricle was measured by radionudide ventriculography In 64 patients during an acute cerebrovascuiar accident. Sixteen patients (12 with coronary artery disease) died within two weeks of the onset of symptoms and had only one EF measurement. In the remaining 48 patients, the EF was also measured two weeks and three months after the acute event. The ejection fraction of the patient who died soon after the acute stroke (52 ± 18) was significantly lower than that of the patients who survived (64 ± 10) (p < 0.01).Of the patients who survived, 28 without history of coronary disease had an EF of 67 ± 10 during the acute event. It was significantly higher than that measured after two weeks (60 ± 10) p < 0.01). In 10 patients with history of chronic stable angina pectoris, the EF (59 ± 10) was significantly lower hi the first study compared to that measured hi the second (69 ± 10) (p < 0.02). Ten patients with no evidence of ischemia but with a history of myocardial infarction had a higher EF (61 ± 1 1 ) during the first study as compared to the second (51 ± 11) (p < 0.05). In all patients there was no significant difference in the EF measurements between the second and the third study. It is suggested that the EF response of the left ventride of the heart to the acute cerebrovascuiar accident is similar to that observed In a stress test. Lowering of the EF during the acute cerebrovascuiar accident in patients with ischemia may be the explanation for the deleterious effect that stroke sometimes has on the heart. Low ejection fraction appears to be a significant risk factor for death soon after stroke. Stroke Vol 17, No 4, 1986IT HAS LONG BEEN RECOGNIZED that damage to the brain affects the heart. Cardiac rhythm abnormalities, ECG abnormalities such as T wave inversion and pulmonary edema have been described in patients with brain lesions, especially with acute cerebrovascuiar accidents. l~9 This brought many authors to suggest that the acute cerebrovascuiar accidents may have a deleterious effect on the function of the heart.3 8 This hypothesis, however, has not been directly proven and the effect of acute stroke on the function of the left ventricle of the heart has not been reported. This problem is especially important in patients with coronary artery disease because atheroma is the pathological basis for both diseases which are often found in the same patient. In this paper the left ventricle ejection fraction response to the acute cerebrovascuiar accident is reported. Methods PatientsThe study group consisted of 64 consecutive patients (36 men, 28 women, average age 71 ± 5 SD years) with acute cerebrovascuiar accident admitted to the emergency ward, in whom radionudide ventriculography (RVG) could be performed. Patients in poor condition who necessitated intensive care and patients who died before radionudide ventriculography could