Association of electrocardiographic and echocardiographic variables with neurological outcomes after ischemic Stroke

Mikhail de Jesus; Ankush Maheshwary; Manish Kumar; Lucas da Cunha Godoy; Chia-Ling Kuo; Prashant Grover

doi:10.1016/j.ahjo.2023.100313

Association of electrocardiographic and echocardiographic variables with neurological outcomes after ischemic Stroke

Am Heart J Plus. 2023 Aug 11:34:100313. doi: 10.1016/j.ahjo.2023.100313. eCollection 2023 Oct.

Authors

Mikhail de Jesus¹, Ankush Maheshwary², Manish Kumar³, Lucas da Cunha Godoy⁴, Chia-Ling Kuo^{4

5}, Prashant Grover⁶

Affiliations

¹ Department of Cardiology, Hartford Hospital, Hartford, CT, USA.
² Department of Neurology, University of Connecticut School of Medicine, Farmington, CT, USA.
³ Department of Critical Care Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, NY, USA.
⁴ The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA.
⁵ Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA.
⁶ Department of Pulmonary and Critical Care Medicine, St. Francis Hospital, Hartford, CT, USA.

Abstract

Background: Cardiac dysfunction is often seen following neurological injury. Data regarding cardiac involvement after ischemic stroke is sparse. We investigated the association of electrocardiographic (ECG) and echocardiographic variables with neurological outcomes after an acute ischemic stroke.

Methods: We retrospectively collected baseline characteristics, stroke location, National Institute of Health Stroke Scale (NIHSS) at the time of admission, acute reperfusion treatment, ECG parameters, and echocardiographic data on 174 patients admitted with acute ischemic stroke. Outcomes of the stroke were based on cerebral performance category (CPC) with a CPC score of 1-2 indicating a good outcome and a CPC score of 3-5 indicating a poor outcome.

Results: Older age (75.31 ± 11.89 vs. 65.16 ± 15.87, p < 0.001, OR = 1.04, 95 % CI 1.01-1.07), higher heart rate (80.63 ± 18.69 vs. 74.45 ± 17.17 bpm, p = 0.024, OR = 1.02, 95 % CI 1.00-1.05) longer QTc interval (461.69 ± 39.94 vs. 450.75 ± 35.24, p = 0.024, OR = 1.01, 95 % CI 0.99-1.02), NIHSS score (60.9 % vs. 17.8 %, p < 0.001, OR = 14.90, 95 % CI 3.83-69.5), and thrombolysis (15 % vs. 5 %, p = 0.049, OR = 0.55, 95 % CI 0.10-2.55) were associated with poor neurological outcomes. However, when adjusted for age and NIHSS, heart rate and QTc were no longer statistically significant. None of the other ECG and echocardiographic variables were associated neurological outcomes.

Conclusions: Elevated heart rate and longer QTc intervals may potentially predict poor neurological outcomes. Further studies are needed for validation and possible integration of these variables in outcome predicting models.

Keywords: ECG; Echo; Echocardiogram; Ischemic; QT interval; Stroke.