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Cerebrovascular disease
Research paper
Echocardiographic wall motion abnormalities in patients with stroke may warrant cardiac evaluation
  1. Shadi Yaghi1,
  2. Andrew D Chang2,
  3. Brittany A Ricci3,
  4. Brian MacGrory2,
  5. Shawna Cutting2,
  6. Tina Burton2,
  7. Katarina Dakay3,
  8. Ryan McTaggart4,
  9. Mahesh V Jayaraman5,
  10. Alexander E Merkler6,7,
  11. Michael Reznik2,
  12. Michael Lerario6,
  13. Ajay Gupta8,
  14. Emile Mehanna9,
  15. Christopher Song10,
  16. David J Seiffge11,
  17. Gian Marco De Marchis12,
  18. Maurizio Paciaroni13,
  19. Hooman Kamel14,
  20. Mitchell S V Elkind15,
  21. Karen L Furie16
  1. 1 Neurology, Columbia University Medical Center, New York City, New York, USA
  2. 2 Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
  3. 3 Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
  4. 4 Radiology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
  5. 5 Diagnostic Imaging, Rhode Island Hospital, Providence, Rhode Island, USA
  6. 6 Neurology, Weill Cornell Medicine, New York City, New York, USA
  7. 7 Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York City, New York, USA
  8. 8 Weill Cornell Medical College, New York City, New York, USA
  9. 9 Cardiology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
  10. 10 Internal Medicine – Cardiovascular Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
  11. 11 Neurology and Stroke Center, University of Basel, University Hospital Basel, Basel, Switzerland
  12. 12 Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
  13. 13 Department of Cardiovascular Medicine, University of Perugia, Perugia, Italy
  14. 14 Neurology and Neuroscience, Weill Cornell Medical College, New York City, New York, USA
  15. 15 Department of Neurology, Columbia University Medical Center, New York City, New York, USA
  16. 16 Neurology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
  1. Correspondence to Dr Shadi Yaghi, Neurology, Columbia University Medical Center, New York City, NY 10027, USA; shadiyaghi{at}yahoo.com

Abstract

Background The aetiology of wall motion abnormalities (WMA) in patients with ischaemic stroke is unclear. We hypothesised that WMAs on transthoracic echocardiography (TTE) in the setting of ischaemic stroke mostly reflect pre-existing coronary heart disease rather than simply an isolated neurocardiogenic phenomenon.

Methods Data were retrospectively abstracted from a prospective ischaemic stroke database over 18 months and included patients with ischaemic stroke who underwent a TTE. Coronary artery disease was defined as history of myocardial infarction (MI), coronary intervention or ECG evidence of prior MI. The presence (vs absence) of WMA was abstracted. Multivariable logistic regression was used to determine the association between coronary artery disease and WMA in models adjusting for potential confounders.

Results We identified 1044 patients who met inclusion criteria; 139 (13.3%, 95% CI 11.2% to 15.4%) had evidence of WMA of whom only 23 (16.6%, 95% CI 10.4% to 22.8%) had no history of heart disease or ECG evidence of prior MI. Among these 23 patients, 12 had a follow-up TTE after the stroke and WMA persisted in 92.7% (11/12) of patients. In fully adjusted models, factors associated with WMA were older age (OR per year increase 1.03, 95% 1.01 to 1.05, p=0.009), congestive heart failure (OR 4.44, 95% CI 2.39 to 8.33, p<0.001), history of coronary heart disease or ECG evidence prior MI (OR 27.03, 95% CI 14.93 to 50.0, p<0.001) and elevated serum troponin levels (OR 2.00, 95% CI 1.06 to 3.75, p=0.031).

Conclusion In patients with ischaemic stroke, WMA on TTE may reflect underlying cardiac disease and further cardiac evaluation may be considered.

http://dx.doi.org/10.1136/jnnp-2018-320219

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    Footnotes

    • Contributors SY: data collection, study concept and design, outcome adjudication, manuscript preparation. ADC: data analysis, manuscript revision. BAR: data collection, manuscript revision. BMG: data collection, manuscript revision. SC: outcome adjudication and data collection. TB: manuscript revision. KD: manuscript revision. RMT: manuscript revision and data collection. MVJ: manuscript revision and data collection. MR: manuscript revision. AEM: manuscript revision, study concept and design. ML: manuscript revision. AG: manuscript revision. EM: manuscript revision. CS: manuscript revision and preparation. DJS: manuscript revision. GMDM: manuscript revision. MP: manuscript revision. HK: manuscript revision, study concept and design. MSVE: manuscript revision, study concept and design. KLF: manuscript revision, study concept and design.

    • Funding This research was supported by the American Heart Association: American Heart Association Award #17MCPRP33670965.

    • Competing interests EM receives personal compensation from Abbott and royalties from UpToDate; research funding from Roche and research contributions in kind from the BMS-Pfizer Alliance for Eliquis® for a trial of stroke prevention in patients with atrial cardiopathy and stroke and EM’s institution receives compensation from Medtronic for EM’s effort on analyses related to atrial fibrillation.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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