TITLE:
Transthoracic echocardiographic and clinical predictors in first versus recurrent ischemic strokes
AUTHORS:
Yasser Bahnacy, Amr Abo Koora, Hamed Dawoud, Wafa Rashed, Ali Sadek
KEYWORDS:
Echocardiography; Risk Factors; Predictors; Ischemic Stroke
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.4 No.2,
February
25,
2014
ABSTRACT: Recurrent strokes are more likely to be disabling or
fatal than first ever strokes. The aim of the study is to evaluate
transthoracic echocardiographic (TTE) and clinical predictors in patients with
first versus those with recurrent ischemic strokes. A prospective observational
comparative study of 217 patients admitted with ischemic strokes who were in
sinus rhythm. Two groups of patients were simultaneously enrolled. The first
group was 110 patients with first ischemic stroke and the second was 107
patients with recurrent ischemic stroke. TTE was done for all patients. Both echocardiographic and clinical risk factors were compared between both groups. Logistic regression analysis identified predictors for recurrent strokes. Among clinical risk factors hypertension,
hyperlipidemia, family history of atherosclerotic vascular disease,
prior coronary artery disease, peripheral vascular disease, and chronic kidney
disease were significantly higher in recurrent stroke group. Multivariate
logistic analysis identified age (OR, 1.03; 95% CI, 1.01 - 1.07), hypertension
(OR, 2.25; 95% CI, 1.03 - 4.92), and hyperlipidemia (OR, 2.73; 95% CI, 1.40 - 5.35),
as predictors for recurrent ischemic strokes. Left ventricular diastolic
dysfunction, left ventricular hypertrophy (LVH) and aortic sclerosis were
significantly more common in the recurrent stroke group compared to the first
stroke group. However, in multivariate logistic analysis only LVH (OR, 3.50;
95% CI, 1.69 - 7.23), was identified as a predictor for recurrent strokes.
Older age, hypertension, hyperlipidemia and left ventricular hypertrophy are
significant predictors of recurrent ischemic strokes in patients with sinus
rhythm. Those patients need more aggressive lipid lowering therapy and optimal
blood pressure control.