title: Left Ventricular Geometry on Transthoracic Echocardiogram and Prognosis after Lacunar Stroke: The SPS3 Trial.
abstract: BACKGROUND
  The spectrum, prevalence, and prognostic implications of abnormal left ventricular geometry (LVG) in patients with lacunar stroke are unknown. We examined the spectrum of LVG and its relationship with vascular risk factors and outcomes after lacunar stroke.
  
  
  METHODS
  LVG was determined with transthoracic echocardiography for 1961 patients with magnetic resonance imaging-verified recent lacunar stroke participating in the Secondary Prevention of Small Subcortical Strokes trial. Multivariable logistic regression and Cox proportional hazards models were used to identify characteristics independently associated with LVG and to estimate risk from abnormal LVG for recurrent stroke and death.
  
  
  RESULTS
  Abnormal LVG was present in 77%. Hispanic (odds ratio [OR], 1.4; 95% confidence interval, 1.1-1.8) or black (OR, 2.0; 1.3-2.9) race-ethnicity, diabetes (OR, 1.3; 1.0-1.7), hypertension, impaired renal function (OR, 1.8; 1.2-2.5), intracranial stenosis (OR, 1.5; 1.1-2.1), and abnormal left ventricular function (OR, 2.0; 1.4-3.0) were independently associated with abnormal LVG. Subjects with abnormal LVG also more frequently had advanced manifestations of small-vessel disease specifically previous subcortical infarcts and white matter hyperintensities. After adjusting for assigned treatments, clinical risk factors, and advanced manifestations of small-vessel disease, subjects with abnormal LVG remained at increased risk of stroke recurrence (hazard ratio, 1.5; confidence interval, 1.0-2.4). There was no interaction between LVG and assigned antiplatelet or blood pressure target. Abnormal LVG was not associated with mortality.
  
  
  CONCLUSIONS
  LVG consistent with chronic hypertensive changes was highly prevalent and correlated with neuroradiologic manifestations of small-vessel disease in lacunar stroke patients. These results support the constructs that both cerebral small-vessel disease and LVG represent end-organ consequences of chronic hypertension.
authors.affiliation: Division of Neurology, Center for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: thalia.field@ubc.ca.
authors.forename: Thalia S
authors.initials: TS
authors.lastname: Field
authors.affiliation: Biostatistical consultant, Minot, North Dakota.
authors.forename: Lesly A
authors.initials: LA
authors.lastname: Pearce
authors.affiliation: Department of Medicine, Hennepin Heart Center, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Asinger
authors.affiliation: Division of Neurology, Center for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Nathan G Chan
authors.initials: NG
authors.lastname: Smyth
authors.affiliation: Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Sabe K
authors.initials: SK
authors.lastname: De
authors.affiliation: Division of Neurology, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Hart
authors.affiliation: Division of Neurology, Center for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Oscar R
authors.initials: OR
authors.lastname: Benavente
mesh_terms: D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D055502:Secondary Prevention; D059409:Stroke, Lacunar / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Lacunar stroke; hypertension; left ventricular geometry; secondary prevention; small-vessel disease; transthoracic echocardiogram
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