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Left ventricular myocardial dysfunction in young and middle-aged ischemic stroke patients

the Norwegian stroke in the young study

Saeed, Sahraia; Gerdts, Evaa,b; Waje-Andreassen, Ulrikec; Fromm, Annettec; Pristaj, Nadiab; Naess, Halvorc; Matre, Knutb

doi: 10.1097/HJH.0000000000001925

Background: Hypertension is highly prevalent in ischemic stroke patients, but less is known about its impact on subclinical left ventricular (LV) dysfunction in such patients.

Methods: Conventional and speckle tracking echocardiography was performed in 276 young (15–44 years) and middle-aged (45–60 years) ischemic stroke patients (mean age 50 ± 9 years, 66% men). Hypertension was defined as a history of hypertension, use of antihypertensive medications, persistently elevated blood pressure (BP) during hospitalization or elevated clinic BP (≥140/90 mmHg) and ambulatory BP (≥130/80 mmHg) at follow-up visits. LV myocardial dysfunction was assessed by peak systolic global longitudinal (GLS) and circumferential strain (GCS).

Results: Hypertension was present in 68% of patients and associated with higher age, BMI and LV mass, male sex and the presence of diabetes (all P < 0.01). Compared with normotensive patients, hypertensive patients had significantly lower peak systolic GLS (−16 ± 3 vs. −19 ± 2%, P < 0.001) and GCS (−16 ± 3 vs. −18 ± 4%, P < 0.001) while ejection fraction did not differ between groups (P = 0.134). In univariable regression analyses, reduced peak systolic GLS and GCS were both associated with hypertension (β = 0.43 and 0.29, respectively, both P < 0.001). The association with hypertension remained significant for GLS (β = 0.25) after adjustment for LV mass, ejection fraction, male sex, obesity and diabetes (multiple R2 = 0.35, P < 0.001), whereas the association of hypertension with reduced peak systolic GCS was attenuated.

Conclusion: In ischemic stroke survivors, hypertension was associated with reduced peak systolic GLS but not GCS independent of confounders.

aDepartment of Heart Disease, Haukeland University Hospital

bDepartment of Clinical Science, University of Bergen

cDepartment of Neurology, Haukeland University Hospital, Bergen, Norway

Correspondence to Sahrai Saeed, MD, PhD, FESC, Department of Heart Disease, Haukeland University Hospital, Jonas Lies veg, 5021 Bergen, Norway. Tel: +47 55972196; fax: +47 55975150; e-mail:

Abbreviations: BP, blood pressure; GCS, global circumferential strain; GLS, global longitudinal strain; LV, left ventricular; LVH, left ventricular hypertrophy; NOR-SYS, Norwegian Stroke in the Young Study; PP/SVi, pulse pressure/stroke volume index

Received 7 June, 2018

Accepted 31 July, 2018

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