Predictors of stroke in patients with severe systolic dysfunction in sinus rhythm: role of echocardiography.
BACKGROUND
Congestive heart failure in sinus rhythm ranks second after atrial fibrillation (AF) among cardiogenic risk-factors for stroke. Clinical and echocardiographic predictors of stroke in this high-risk population remain poorly defined.


METHODS
Retrospective screening of 1886 consecutive patients with severe systolic dysfunction (LVEF ≤35%) at a tertiary medical center echocardiography database (Nov 2005-Sep 2008) identified 83 patients in sinus rhythm with cardioembolic stroke. Patients with AF on follow-up, prosthetic valve, ventricular arrhythmia and lack of consensus between reviewing neurologists were excluded (n=10). Consecutive age and gender-matched controls in sinus rhythm formed GpII (n=73).


RESULTS
The incidence of stroke was 3.9% (73/1886) over 35 months in this study. There were no significant differences in prevalence of established clinical risk-factors for stroke. There was a significantly higher prevalence of LV non-compaction (p=0.02), aneurysm (p<0.01), spontaneous echo-contrast (p<0.01) and pulmonary hypertension (p<0.001) in GpI.


CONCLUSIONS
LV non-compaction, aneurysm, spontaneous echo-contrast and pulmonary hypertension are associated with an increased risk of stroke. While anticoagulation of these high-risk subgroups appears reasonable, further study in a prospective randomized clinical trial merits consideration.
Mahajan
Nitin
N
Ganguly
Joya
J
Simegn
Mengistu
M
Bhattacharya
Pratik
P
Shankar
Lakshmi
L
Madhavan
Ramesh
R
Chaturvedi
Seemant
S
Ramappa
Preeti
P
Afonso
Luis
L
D000368:Aged; D016022:Case-Control Studies; D004452:Echocardiography / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology; D013599:Systole / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging*