Left ventricular structure aids in risk prediction for stroke survivors

Echocardiographic assessment of left ventricular (LV) geometry could help predict outcomes in stroke survivors, according to research published online March 5 in JACC: Cardiovascular Imaging.

Lead researcher Chan Soon Park, MD, with Seoul National University Hospital, and colleagues studied 2,069 patients admitted to their hospital with acute ischemic stroke between 2002 and 2010.

They found patients with concentric LV hypertrophy demonstrated a 42 percent increased risk of all-cause mortality when compared to normal geometry over a median follow-up of 37.6 months. Concentric remodeling was associated with a 54 percent increased risk of death, while eccentric hypertrophy showed an insignificant risk increase versus normal LV structure.

Relative wall thickness (RWT) was also an independent predictor of all-cause mortality—an additional 15 percent risk per 0.1-unit increase in RWT.

“The clinical significance of LV mass and geometry has been extensively explored in various cardiovascular diseases, including coronary artery disease, post-myocardial infarction, and preserved LV ejection fraction,” the researchers wrote. “However, there is a paucity of data on the prognostic implications of LV geometry in patients with ischemic stroke, although it has been reported that LV hypertrophy and abnormal geometry are associated with an increased risk of developing ischemic stroke.”

Park and coauthors found adding echocardiographic-derived factors to the National Institutes of Health Stroke Scale (NIHSS) incrementally improved prediction of both cardiovascular and all-cause mortality. Specifically, when RWT and LV mass index were incorporated with the NIHSS score, it improved the area under the curve—a measure of predictive value—from 0.672 to 0.699 for all-cause death and from 0.703 to 0.751 for cardiovascular death.

“Echocardiography is widely used in patients with acute ischemic stroke to assess for the presence of cardiac sources of emboli,” Thierry C. Gillebert, MD, PhD, and Julio A. Chirinos, MD, PhD, wrote in a related editorial. “Therefore, the identification of echocardiographic parameters that can aid in the risk stratification of this patient population could be readily applied in clinical practice, without additional cost.”

Importantly, the study included only patients at a South Korean hospital, so the findings may not be generalizable to other racial or ethnic groups. In addition, the researchers were unable to break down their results by stroke subtypes.

“The findings of Park et al. should prompt more tailored studies to examine the mechanisms of the interaction between LV remodeling, BP (blood pressure), and arterial hemodynamics as prognostic factors after acute ischemic stroke,” Gillebert and Chirinos wrote. “Similarly, whether antihypertensive therapy should be tailored according to the prevalent LV geometry in patients with ischemic stroke remains to be addressed in properly designed prospective clinical trials.”