Cardiac complications following cerebrovascular disease

Abstract

Background: Accumulating evidence suggest that cardiac complications after stroke are an important yet understudied manifestation of brain-heart interactions. Our aim was to investigate and compare cardiac findings after different cerebrovascular events (acute ischemic stroke, transient ischemic attack, and hemorrhagic stroke). Methods: 7113 patients treated between December 2013 and December 2020 at the University Hospital Zurich for ischemic stroke, transient ischemic attack, and hemorrhagic stroke were screened. 721 patients without evidence of previous cardiac disease or presumed cardioembolic origin of their cerebrovascular disease and with at least one cardiac check-up were included. Clinical reports from the year following disease onset were screened for new cardiac findings, which were categorized as arrhythmia/electrocardiographic (ECG) changes, myocardial alterations, valvular abnormalities, coronary perfusion insufficiency, and hypotensive/hypertensive blood pressure abnormalities. Differences in proportions of findings between groups were analyzed using Pearson?s Chi-Square Test or Fisher?s exact Test. Results: ECG changes were observed in 81.7% of patients with ischemic stroke, 71.4% with transient ischemic attack, and 55.8% with hemorrhagic stroke (p<0.001). Myocardial alterations occurred often in all three groups (60.9% ischemic stroke, 59.2% transient ischemic attack, 44.2% hemorrhage, p=0.1). Hypotensive/hypertensive blood pressure abnormalities were most frequent (48.8%) in hemorrhagic stroke patients (p<0.001). Conclusions: Cardiac complications are frequent in patients with cerebrovascular disease, even without prior cardiac problems or suspected cardiac etiology. While findings were different in the three event types, our data suggest that all patients with acute cerebrovascular events should receive thorough workup searching for cardiac complications.