Abstract 2785: Electrocardiographic ST-T Changes In Patients With Acute Ischemic Stroke Are Cardiac In Origin
Background: ST-segment depression and T-wave inversion (ST-T changes) in the electrocardiogram (ECG) and raised levels of natriuretic peptide have been observed in acute ischemic stroke patients. Natriuretic peptides are associated with myocardial ischemia in patients with established coronary artery disease. However, it is unknown whether any relation between ST-T changes and raised levels of natriuretic peptides in patients with an acute ischemic stroke exists.
Hypothesis: We assessed the hypothesis that ST-T changes suggestive of myocardial ischemia in the setting of acute ischemic stroke are associated with elevated levels of NT-proBNP.
Methods: Serial measurements of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) and 12-lead ECGs were obtained in 192 consecutive patients with an acute ischemic stroke, but without known ischemic heart disease, atrial fibrillation, systolic heart failure or renal insufficiency. ST-T changes suggestive of myocardial ischemia were defined as ST-depression ≥ 0.1 mV and/or T-wave inversion ≥ 0.1 mV.
Results: Electrocardiographic ST-T changes suggestive of myocardial ischemia were observed in the 12 lead ECG of 47 patients (24 %). None of the 192 patients had chest pain or discomfort during measurements. The level of NT-proBNP was significantly higher in the 47 patients with (median 376 pg/ml (10th to 90th percentile, 68 to 1467 pg/ml)) than in the 145 patients without ST-T changes (median 138 pg/ml (10th to 90th percentile, 31 to 785 pg/ml)) (p < 0.001). There was no dose - response association between the ECG changes and levels of NT-proBNP. In multivariate regression analysis after adjustment for age, stroke severity, female sex, systolic blood pressure, diabetes mellitus, and levels of troponin T > 0.03 μg/L, ST-T changes in the ECG remained associated with increased levels of NT-proBNP (β = 76.5, p = 0.011).
Conclusions: Electrocardiographic ST-T changes suggestive of myocardial ischemia are independently and significantly associated with the levels of NT-proBNP in patients with acute ischemic stroke. This association indicates that the ST-T changes are cardiac in origin. The clinical importance of this new observation needs to be clarified in a larger follow-up study.