Clinical and echocardiographic differences between ıschemic and hemorrhagic stroke: a sex-stratified retrospective analysis

Objective To compare clinical and echocardiographic characteristics of ischemic and hemorrhagic stroke using sex-stratified analyses and to assess whether routine echocardiographic findings provide complementary cardiovascular information.Methods This retrospective observational study included 220 adults with neuroimaging-confirmed stroke treated at a secondary-care hospital specializing in physical medicine and rehabilitation between January 2023 and December 2024. Patients were classified as having ischemic stroke (n = 171) or hemorrhagic stroke (n = 49). Demographic characteristics, cardiovascular comorbidities, and routinely reported transthoracic echocardiographic findings were analyzed. Separate multivariable logistic regression models were constructed for women and men using variables with p < 0.10 in univariate analyses.Results Patients with ischemic stroke were older than those with hemorrhagic stroke (68.4 ± 10.6 vs. 63.4 ± 13.9 years; p = 0.022), and hypertension was more frequent (94.2% vs. 81.6%; p = 0.017). Among men, left ventricular diastolic dysfunction (48.1% vs. 24.1%; p = 0.021) and hypertension (95.2% vs. 79.3%; p = 0.014) were more frequent in ischemic stroke. In the male multivariable model, left ventricular diastolic dysfunction (OR = 4.835, 95% CI 1.593–14.679; p = 0.005) and hypertension (OR = 9.471, 95% CI 2.053–43.691; p = 0.004) were independently associated with ischemic rather than hemorrhagic stroke, whereas ascending aortic dilatation showed an inverse association (OR = 0.235, 95% CI 0.080–0.692; p = 0.009). No variable was independently associated with stroke subtype in women.Conclusion Sex-stratified analyses identified different cardiovascular association patterns across stroke subtypes. Routine echocardiographic findings, particularly left ventricular diastolic dysfunction, may complement cardiovascular characterization in men with stroke. These exploratory findings require confirmation in larger prospective multicenter studies with formal interaction testing.