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Prognostic significance of acute hypertensive response in ischemic stroke or transient ischemic attack patients and its relationship with left ventricular myocardial function

Yi, Jeong-Euna; Chang, Yoonkyungb; Song, Tae-Jinb; Shin, Gil Jac; Kim, Yong-Jaed

doi: 10.1097/HJH.0000000000002171
ORIGINAL PAPERS: Epidemiology
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Objectives: Acute hypertensive response (AHR) in acute stroke is associated with adverse outcomes; however, the underlying pathophysiology of the association is poorly understood and its prognostic impact in ischemic stroke remains unclear. We aimed to investigate the prognostic significance of AHR in patients with ischemic stroke or transient ischemic attack (TIA), and further examined the relationship between AHR and myocardial function, using two-dimensional speckle-tracking echocardiography (2D-STE).

Methods: A total of 244 consecutive patients with acute ischemic stroke (AIS) (n = 192) or TIA (n = 52), who were evaluated with 2D-STE within 7 days from admission, were retrospectively analysed. The primary endpoint was a composite of major adverse cardiovascular and cerebrovascular events (MACCE), including death, myocardial infraction or recurrent ischemic stroke.

Results: Among the study population, AHR was observed in 161 (66%) patients. During a mean follow-up of 21.0 ± 12.5 months, 29 patients (11.9%) [25 (15.5%) AHR vs. 4 (4.8%) No AHR, P = 0.014] reached the primary endpoint. A Kaplan–Meier curve revealed that patients with AHR had a significantly higher incidence of MACCE than those without AHR (log-rank P = 0.013). Multivariate Cox regression analysis demonstrated that AHR [adjusted hazard ratio 4.60, 95% confidence interval (95% CI) 1.31–16.15] was a strong predictor of MACCE. In multivariate logistic regression analysis, left ventricular global longitudinal strain (per 1% decrease) showed a significant relationship with AHR (adjusted odds ratio 1.17, 95% CI 1.02–1.35).

Conclusion: AHR in patients with AIS or TIA may be an important poor prognostic marker related to myocardial dysfunction.

aDivision of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea

bDepartment of Neurology

cDivision of Cardiology, Department of Internal Medicine, Ewha Womans Mokdong's Hospital, Ewha Womans University School of Medicine

dDepartment of Neurology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea

Correspondence to Yong-Jae Kim, MD, PhD, Department of Neurology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul 03312, South Korea. Tel: +82 2 2030 2599; fax: +82 2 2030 4641; e-mail: brain930@gmail.com

Abbreviations: 2D, two-dimensional; AHR, acute hypertensive response; AIS, acute ischemic stroke; ApoB/A1, apolipoprotein B/A1 ratio; baPWV, brachial-ankle pulse wave velocity; BP, blood pressure; CAD, coronary artery disease; CT, computed tomography; GLS, global longitudinal strain; hs-cTnT, high-sensitive cardiac troponin T; LDL, low-density lipoprotein; LV, left ventricular; LVEDD, left ventricular end-diastolic diameter; LVEF, left ventricular ejection fraction; LVH, left ventricular hypertrophy; LVMI, left ventricular mass index; MACCE, major adverse cardiac and cerebrovascular event; NIHSS, National Institutes of Health Stroke Scale; PWd, posterior wall thickness at end-diastole; RWT, relative wall thickness; STE, speckletracking echocardiography; TIA, transient ischemic attack; TOAST, Trial of Org 10172 in Acute Stroke Treatment; TTE, transthoracic Doppler echocardiography

Received 12 March, 2019

Revised 8 May, 2019

Accepted 19 May, 2019

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