P1837 The severity of acute ischemic stroke is associated with the right heart remodeling in patients with arterial hypertension
Authors: Serova D , Serov V , Shutov A , Efremova E , Braun A , Kovalenko A 
Published: January 2020

Abstract

It is known, that the right heart structural and functional abnormalities play an important role in the disregulation of venous return, however their role in the pathogenesis of ischemic stroke is still unclear.

Purpose
The aim of this study was to determine the relationship of echocardiographic signs of the right heart remodeling and the stroke severity in patients with arterial hypertension and ischemic stroke.

Methods
98 patients with acute ischemic stroke (31 females and 67 males, mean age was 68.2 ± 12.1 years) were studied. All patients had arterial hypertension. Most of them (96.9%) had grade 3 hypertension according to ESH/ESC Guidelines for the management of arterial hypertension, 2018. Forty-two (43.1%) patients had coronary artery disease, 35 (35.4%) - atrial fibrillation (AF). The exclusion criteria was the presence of chronic obstructive pulmonary disease or other diseases associated with pulmonary hypertension. Patients were categorized according to National Institutes of Health Stroke Scale (NIHSS) severity in mild NIHSS (≤8) - 54 (55.1%) patients, moderate NIHSS (9–15) - 23 (23.5%) patients, and severe stroke NIHSS (≥16) - 21 (21.4%) patients. Median NIHSS score was 11.2 ± 1.7. All patients underwent a transthoracic echocardiography. A comparative assessment of echocardiographic parameters was performed in patients of lower (NIHSS score ≤ 4.5) and upper (NIHSS score≥14.5) quartile according to the NIHSS score.

Results
Linear regression analysis revealed that stroke severity was significantly correlated with right atrium end-diastolic volume (EDV) (r = 0.48, p &lt; 0.0001), right ventricular EDV (r = 0.62, p &lt; 0.0001), left atrium EDV (r = 0.41, p = 0.002), left ventricular ejection fraction (LVEF) (r = 0.4, p = 0.003) and pulmonary artery systolic pressure (PASP) (r = 0.89, p &lt; 0.0001). A multiple regression analysis showed that stroke severity was independently correlated with PASP (β=0.471, р=0.01), left atrium EDV (β=0.961, р=0.02) and LVEF (β=0.931, р=0.005) in patients with arterial hypertension and ischemic stroke.
In the group of patients with the upper quartile of NIHSS score, the right atrium EDV (64.7 ± 21.1 mm versus 47.6 ± 25.2 mm, р=0.04) and PASP (25.8 ± 9.3 mm versus 20.8 ± 8.0 mm, р=0.045) were higher. The left atrium EDV was higher in patients with LVEF below 50% ( 73.3 ± 36.9 mm vs 49.9 ± 18.5 mm, р=0.02) and in patients with AF (55.3 ± 19.8 vs 36.4 ± 14.6 mm, p &lt; 0.0001). At the same time PASP did not depend on the LVEF (22.1 ± 10.7 mm vs 21.6 ± 8.1 mm, р=0.9) and the presence of AF (21.9 ± 9.0 mm vs 21.7 ± 8.1 mm, р=0.9).

Conclusions
In patients with arterial hypertension the severity of acute ischemic stroke is associated with increases in right atrium end-diastolic volume and in pulmonary artery systolic pressure. An increase in pulmonary artery systolic pressure in patients with arterial hypertension and ischemic stroke does not depend on the left ventricular ejection fraction and atrial fibrillation.