Echocardiographic Features of Patients with Stroke in Port Harcourt, Nigeria

Abstract

Stroke is a major challenge to physicians worldwide, with a high incidence, mortality, disability rates and costs. Systemic hypertension (SH) is the most dominant risk factor for the development of stroke. It results in left ventricular hypertrophy (LVH) which is a strong risk factor for cardiovascular events. Cardiac structural and functional abnormalities have been associated with cardioembolic stroke, which has a relatively high likelihood of recurrence, hence secondary prevention is important. Transthoracic echocardiogram (TTE) is a non-invasive procedure that can be performed to screen for cardiac structural abnormalities and sources of emboli in stroke patients. Aim: The aim of the study was to determine the echocardiographic structural abnormalities in stroke patients. Methods: A cross sectional study of cardiac structural abnormalities in 100 stroke patients using echocardiography was carried out. Healthy normotensive controls matched for age and sex were selected for comparison. Patients who were less than 40 years, hemodynamically unstable or pregnant were excluded. Results: One hundred patients (61 males and 39 females) and 80 healthy controls (51 males and 29 females) were enrolled. There were more males than females in a ratio of 1.6:1 for the patients and 1.3:1 for the controls. Mean age of patients was 57.7 ± 8.4 years and 57.1 ± 8.8 years for controls. Mean body mass index was 27.8 ± 5.48 kg/m2 in patients and 27.6 ± 4.72 kg/m2 in controls. Left ventricular mass index of > 110 g/m2 in females and > 134 g/m2 in males was considered abnormal.  The mean left ventricular mass index was higher in patients than in controls (140.3 ± 43.1 g/m2 versus 88.1 ± 24.3 g/m2; p < 0.001). Left ventricular hypertrophy was present in 60% of patients and 7.5% of controls (p < 0.001). Potential cardiac sources of embolism was found in 47% of the patients which includes left atrial dilatation (27%), left atrial dilatation with spontaneous echocardiographic contrast (3%), atrial fibrillation (7%), intracardiac thrombus (6%) and valvular heart disease (4%). Conclusion: Stroke patients have a high prevalence of LVH and potential cardiac sources of embolism which can be identified by echocardiography.