Assessment of Myocardial Function by Myocardial Performance Index in Patients with Acute Ischemic Stroke

Year 2019, Volume: 46 Issue: 4, 715 - 723, 15.12.2019

Unal Ozturk , Onder Ozturk

https://doi.org/10.5798/dicletip.661265

Abstract

Objective: Acute stroke is an important cause of morbidity and mortality. Myocardial injury is an important complication of acute cerebrovascular events. In this study, we aimed to investigate the relationship between myocardial function assessed by myocardial performance index (MPI) and National Institutes of Health Stroke Scale (NIHSS) score in patients with acute ischemic stroke.
Method: The study comprised 97 patients (males, 42; females, 55; 65 ± 16 years) diagnosed with acute ischemic stroke. 17 patients were excluded. Patients were divided into two groups based on the calculated NIHSS score (Group 1, NIHSS score < 16; Group 2, NIHSS score ≥ 16). Demographic, clinical, and laboratory data for all patients were collected. Cardiac function was evaluated by transthorasic echocardiography within 48 hours of admission to the neurology care unit.
Results: There were no significant differences among demographic parameters of patients. MPI was significantly higher in Group 2 patients than in Group 1 patients (0.59±0.25 vs 0.48±0.20, p=0.004).
Conclusion: Our results suggest that MPI is associated with stroke severity on admission in patients with acute ischemic stroke. MPI is an indicator of global myocardial dysfunction with a different from LVEF. MPI, which includes both systolic and diastolic time intervals is an option to assess the global cardiac dysfunction.

Keywords

Ventricular dysfunction, left ventricular

References

• 1. Rojek A, Gąsecki D, Fijałkowski M, et al. Left ventricular ejection fraction and aortic stiffness are independent predictors of neurological outcome in acute ischemic stroke. J Hypertens. 2016; 34: 2441-8. 2. Malik AN, Gross BA, Rosalind Lai PM, et al. Neurogenic Stress Cardiomyopathy After Aneurysmal Subarachnoid Hemorrhage. World Neurosurg. 2015; 83: 880-5. 3. Kerro A, Woods T, Chang JJ. Neurogenic stunned myocardium in subarachnoid hemorrhage. J Crit Care. 2017; 38: 27-34. 4. Ermis E, Demirelli S, Ceylan M, et al. The evaluation of myocardial function of patients in the early stage of acute ischemic stroke by two-dimensional speckle tracking echocardiography. J Clin Ultrasound. 2016; 44: 305-11. 5. Ozturk O, Ulgen MS, Tekes S, Ozturk U, Toprak N. Influence of the Angiotensin Converting Enzyme I/D Gene Polymorphisms on Right Ventricular Myocardial Performance Index in Patients With a First Acute Anterior Myocardial Infarction. Circ J. 2005; 69: 211-5. 6. Öztürk Ö, Toprak N. Akut Anteriyor Miyokard İnfarktüslü Hastalarda Geliş Miyokardiyal Performans İndeksi ile Lökositoz Arasındaki İlişki. Dicle Med J. 2004; 2: 36-41. 7. Lyden P. Using the National Institutes of Health Stroke Scale: A Cautionary Tale. Stroke. 2017; 48: 513-19. 8. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28: 1-39. 9. Tei C, Nishimura RA, Seward JB, Tajik AJ. Noninvasive Doppler derived myocardial performance index: Correlation with simultaneous measurement of cardiac catheterization measurements. J Am Soc Echocardiogr. 1997; 10: 169–78. 10. Zawadka-Kunikowska M, Slominski K, Slomko J, et al. Comprehensive non-nvasive cardiac and autonomic assessment in acute ischaemic strokepatients: pilot study. Minerva Cardioangiol. 2018; 66: 376-85. 11. Vemmos K, Ntaios G, Savvari P, et al: Stroke etiology and predictors of outcome in patients with heart failure and acute stroke: a 10-year follow-up study. Eur J Heart Fail. 2012; 14: 211-8. 12. Holmström A, Fu ML, Hjalmarsson C, Bokemark L, Andersson B. Heart dysfunction in patients with acute ischemic stroke or TIA does not predict all-cause mortality at long-term follow-up. BMC Neurol. 2013; 23: 122. 13. Ripoll JG, Blackshear JL, Díaz-Gómez JL. Acute Cardiac Complications in Critical Brain Disease. Neurosurg Clin N Am. 2018; 29: 281-97. 14. Constantinescu V, Matei D, Cuciureanu D, et al. Cortical modulation of cardiac autonomic activity in ischemic stroke patients. Acta Neurol Belg. 2016; 116: 473-80. 15. Biso S, Wongrakpanich S, Agrawal A, et al. A Review of Neurogenic Stunned Myocardium. Cardiovasc Psychiatry Neurol. 2017; 2017: 5842182. 16. Mierzewska-Schmidt M, Gawecka A. Neurogenic stunned myocardium - do we consider this diagnosis in patients with acute central nervous system injury and Dicle Tıp Dergisi / Dicle Med J (2019) 46 (4) : 715 - 723 acute heart failure? Anaesthesiol Intensive Ther. 2015; 47: 175-80. 17. Kim WJ, Nah HW, Kim DH, et al. Association between Left Ventricular Dysfunction and Functional Outcomes at Three Months in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis. 2016; 25: 2247-52. 18. Milionis H, Faouzi M, Cordier M, et al. Characteristics and early and long-term outcome in patients with acute ischemic stroke and low ejection fraction. Int J Cardiol. 2013; 168: 1082-7. 19. Sung PH, Chen KH, Lin HS, et al. The Correlation between Severity of Neurological Impairment and Left Ventricular Function in Patients after Acute Ischemic Stroke. J Clin Med. 2019; 8. pii: E190. doi: 10.3390/jcm8020190. 20. Bonardo P, Pantiú F, Ferraro M, et al. Impact of Infarct Size on Blood Pressure in Young Patients with Acute Stroke. J Vasc Interv Neurol. 2018; 10: 14-6. 21. Hendrix P, Sofoluke N, Adams MD, et al. Risk Factors for Acute Ischemic Stroke Caused by Anterior Large Vessel Occlusion. Stroke. 2019; 50: 1074-80. 22. Chang A, Ricci B, Grory BM, et al. Cardiac Biomarkers Predict Large Vessel Occlusion in Patients with Ischemic Stroke. J Stroke Cerebrovasc Dis. 2019 Mar 19. pii: S1052-3057(19)30057-6. doi: 10.1016/j.jstrokecerebrovasdis 2019.02.013. 23. Lindsberg JP, Roine RO. Hyperglycaemia in acute stroke. Stroke. 2004; 35: 363-4. 24. Ryu WS, Bae EK, Park SH, et al. Increased Left Ventricular Filling Pressure and Arterial Occlusion in Stroke Related to Atrial Fibrillation. J Stroke Cerebrovasc Dis. 2018; 27: 1275-82. 25. Mostofsky E, Wellenius GA, Noheria A, et al. Cerebrovasc Dis. 2009; 28: 88-94.