Heart dysfunction in patients with acute ischemic stroke or TIA does not predict all-cause mortality at long-term follow-up

Abstract

BackgroundDespite heart failure being a substantial risk factor for stroke, few studies have evaluated the predictive value of heart dysfunction for all-cause mortality in patients with acute ischemic stroke, in particular in the elderly. The aim of this study was to investigate whether impaired heart function in elderly patients can predict all-cause mortality after acute ischemic stroke or transient ischemic attack (TIA).MethodsA prospective long-term follow-up analysis was performed on a hospital cohort consisting of n = 132 patients with mean age 73 ± 9 years, presenting with acute ischemic stroke or transient ischemic attack, without atrial fibrillation. All patients were examined by echocardiography during the hospital stay. Data about all-cause mortality were collected at the end of the follow-up period. The mean follow-up period was 56 ± 22 months.ResultsIn this cohort, 58% of patients with acute ischemic stroke or TIA had heart dysfunction. Survival analysis showed that heart dysfunction did not predict all-cause mortality in this cohort. Furthermore, in multivariate regression analysis age (HR 5.401, Cl 1.97-14.78, p < 0.01), smoking (HR 3.181, Cl 1.36-7.47, p < 0.01), myocardial infarction (HR 2.826, Cl 1.17-6.83, p < 0.05) were independent predictors of all-cause mortality.ConclusionIn this population with acute ischemic stroke or TIA and without non-valvular atrial fibrillation, impaired heart function does not seem to be a significant predictor of all-cause mortality at long-term follow-up.

Experimental ischaemic stroke induces transient cardiac atrophy and dysfunction

“…In echocardiography, performed after acute stroke, 20-30% of stroke patients have focal or generalized contractile abnormalities, and 7% suffer from overt heart failure with left ventricular ejection fraction below 30%. 3 These features are commonly interpreted as a reflection of pre-existing heart disease rather than as a consequence of the stroke. While there is a documented history of pre-existing heart disease in some patients, longitudinal clinical studies monitoring heart function before and after stroke do not exist.…”

“…Vice versa, acute stroke can affect cardiac function. A plethora of clinical manifestations comprising reduced heart rate, atrial fibrillation, cardiac dysfunction, elevated troponin, and stress‐induced acute cardiomyopathy can be found in stroke patients. Cardiac disease also contributes substantially to the long‐term prognosis of ischaemic stroke patients .…”

“…Cardiac disease also contributes substantially to the long‐term prognosis of ischaemic stroke patients . The conventional explanation for this is that cardiac disorders in stroke patients result from shared vascular risk factors leading to concomitant ischaemic manifestations in the heart and the brain in the same patients . Alternatively, brain injury may have a long‐term effect on other organs including the heart.…”

Relevance of Heart Failure in Prevention, Treatment and Prognosis of Ischemic Stroke

“…Previous cohort studies suggest that stroke patients with pre-existing HF have a two-to three-times higher probability to suffer severe stroke compared to patients without HF [7]. Moreover, in the majority of studies mortality has been observed to be 2-2.5-fold higher in patients with HF compared to patients without HF [5,31]. Notably, in stroke patients with HF, the risk of dying -which is about 80 % over a period of five years -is not further increased in the presence of AF [8,32].…”

Bedeutung der Herzinsuffizienz für Prävention, Therapie und Prognose des ischämischen Schlaganfalls

“…Die veröffentlichten (zumeist retrospektiven) Kohortenstudien zur Relevanz der (chronischen) HI für die Sterblichkeit nach Schlaganfall sind heterogen, zeigen jedoch in der Mehrzahl eine bestehende Assoziation [31] mit einem etwa 2-2,5-fach erhöhten Wahrscheinlichkeit zu sterben im Vergleich zu Schlaganfallpatienten ohne HI (zur Übersicht: 5). Interessanterweise scheint bei herzinsuffizienten Schlaganfallpatienten das additive Bestehen eines Vorhofflimmerns das Risiko zu sterben nicht weiter zu erhöhen [8,32], das über einen Zeitraum von 5 Jahren etwa 80 % zu betragen scheint [8].…”