Arq Bras Cardiol: Imagem cardiovasc 2020; 33(4): 1-7

Longitudinal Strain and Ischemic Stroke in the Absence of Known Heart Disease

DOI: 10.47593/2675-312X/20203304eabc101

Abstract

Background

Stroke is prevalent worldwide, and early recognition of subclinical cardiovascular (CV) disease could predict a first ischemic stroke (IS) episode. Speckle-tracking echocardiography (STE) allows the detection of early subclinical myocardial dysfunction.

Aim

To examine the association between myocardial deformation, evaluated by STE, and first episode of IS in a sample of otherwise healthy patients.

Methods

We included individuals between 40–80 years old, with a first incidence of IS, with no known CV disease, matched to healthy controls by sex, age, and hypertension at a 1:2 ratio. STE was used to assess LV global longitudinal strain (GLS), and traditional echocardiography was performed. Univariate and multivariable analyses were performed to assess the relationship among stroke, CV risk factors, and echocardiography-derived parameters.

Results

A total of 29 cases and 62 controls were included. The mean age of the patients was 60 ± 12 y/o, and 54% were males. Smoking was more prevalent in cases compared to controls (34% vs. 9%; p = 0.001), and there were no significant differences in the other examined risk factors. Cases had less myocardial deformation compared to controls (GLS: -16.7% ± 3.4% vs. -19.2 ± 2.8%; p < 0.001), and there was no significant difference regarding traditional echocardiography parameters. After adjusting for smoking and hyperlipidemia, GLS maintained an independent association with stroke (OR = 1.3; 95% CI, 1.1–1.6; p = 0.005). The area under the ROC curve for stroke significantly increased after adding GLS to smoking (0.65 to 0.78, p = 0.009).

Conclusion

GLS has a consistent and independent association with a first IS episode in middle-aged adults with generally normal hearts. Therefore, GLS may be a useful risk marker in this population.