Prevalence, associated factors and prognostic value of impaired left ventricular strain in patients with ischemic stroke

Background Patients with ischemic stroke are at higher risk for heart failure (HF) occurrence, but individual risk prediction remains challenging. Left ventricular global longitudinal strain (LVGLS) can unmask subclinical LV functional impairment. Purpose To investigate the prevalence, associated factors, and prognostic significance of LVGLS in patients with acute ischemic stroke. Methods This observational study included 315 patients with acute ischemic stroke who underwent transthoracic echocardiography. LVGLS was assessed using speckle-tracking echocardiography, and impaired LVGLS was defined as <16%. The primary outcome was a composite of new-onset HF and all-cause mortality. Results Among the study patients, 92 (29.2%) had impaired LVGLS. Male sex, ischemic heart disease and impaired renal function were associated with reduced LVGLS (all P<0.05). During a median follow-up of 34 months, 61 patients (19.4%) reached primary outcome. Patients with impaired LVGLS were at higher risk for primary outcome compared with those with preserved LVGLS (Log-rank p=0.010; Figure). Multivariate Cox proportional hazards analyses identified LVGLS as an independent predictor for composite endpoint (adjusted hazard ratio [aHR] 1.06 per 1% decrease; p=0.033). The association was consistent in patients with preserved LV ejection fraction (aHR 1.07 per 1% decrease; p=0.040) or those without history of HF (aHR 1.06 per 1% decrease; p=0.038). Conclusions Approximately 30% of patients with ischemic stroke had impaired LVGLS, which was associated with an increased risk of HF and mortality. Assessment of LVGLS may provide valuable information for risk stratification in patients with acute ischemic stroke.