September 1, 1994Open Access
View Full PaperST segment depression detected by continuous electrocardiography in patients with acute ischemic stroke or transient ischemic attack.
Key Result
Continuous electrocardiography detected ST segment depression in 29% (95% CI 15-43%) of patients with acute ischemic stroke or TIA, significantly predicted by left-sided neurological events (P<0.01).
Study Design
Type
Observational (n=51)
Structured PICO
What is the prevalence of ST segment depression and ventricular arrhythmias detected by continuous electrocardiography in patients with acute ischemic stroke or TIA?
P
Population
51 consecutive patients with acute ischemic stroke or TIA, monitored by continuous electrocardiography for 48 hours.
E
Exposure
Continuous electrocardiography monitoring for 48 hours
O
Outcome
Prevalence of ST segment depression and ventricular arrhythmiassurrogate
Continuous ECG monitoring reveals a 29% prevalence of ST segment depression in acute ischemic stroke or TIA patients, with left-sided events being a significant predictor, suggesting a neurologically mediated mechanism.
Abstract
BACKGROUND AND PURPOSE: Forty percent of patients with a history of ischemic stroke or transient ischemic attack (TIA) have concomitant coronary artery disease. ST segment depression, detected by continuous electrocardiography, is associated with increased cardiac morbidity and mortality in patients with known coronary artery disease. While electrocardiographic changes have been associated with acute stroke, the etiology and significance of these changes remain unclear. In this pilot study we report the prevalence of ST segment depression and ventricular arrhythmias in patients with acute ischemic stroke or TIA monitored by continuous electrocardiography. Clinical predictors of ST segment depression and ventricular arrhythmia are also identified. METHODS: Consecutive patients presenting with acute ischemic stroke or TIA were enrolled within 72 hours of hospital admission and monitored by continuous electrocardiography for 48 hours. The electrocardiographic results were analyzed for periods of ST segment depression and ventricular arrhythmias. RESULTS: Of 51 patients with ischemic stroke or TIA, 15 (29%) had episodes of ST segment depression (95% confidence interval, 15% to 43%), and 18 (35%) had ventricular arrhythmias (95% confidence interval, 21% to 49%). In logistic regression analysis, increasing age (P < .02) and a left-sided neurological event (P < .01) were significant predictors of ST segment depression. Increasing numbers of atherosclerotic risk factors, a history of cardiac disease, and increasing or decreasing mean arterial pressure were not predictive of ST segment depression. CONCLUSIONS: Patients with acute ischemic stroke or TIA have a 29% prevalence of ST segment depression within the first 5 days after their event. In comparison, the prevalence of ST depression is 2.5% to 8% in asymptomatic adults and 43% to 60% in patients with symptomatic coronary artery disease. The association of ST segment depression with left-sided neurological events suggests that the electrocardiographic changes are in part neurologically mediated. Further study is necessary to better define the brain-heart interaction and to determine whether ST segment depression in patients with ischemic stroke or TIA reflects underlying coronary artery disease.