dic Arquivos Brasileiros de Cardiologia Imagem cardiovascular Arq Bras Cardiol: Imagem cardiovasc 2675-312X Sociedade Brasileira de Cardiologia eabc101 10.47593/2675-312X/20203304eabc101 Original Article Longitudinal Strain and Ischemic Stroke in the Absence of Known Heart Disease Strain Longitudinal e Acidente Vascular Encefálico Isquêmico na Ausência de Cardiopatia Conhecida Morais Jeova Cordeiro de Junior 1 2 Salvioni Nayane Carolina Pertile 1 Lima Dannyl Roosevelt de Vasconcelos 1 Confessor Crissvânia Firmino 1 Galdino Alexsandro Paulo Costa Junior 1 Cardoso Lara Sodré 1 Silva Antônio Marconi Leandro da 1 Lima Joao 4 Armstrong Anderson da Costa 1 Correia Luis Claudio Lemos 2 3 Federal University of São Francisco Valley Petrolina Pernambuco Brazil Federal University of São Francisco Valley, Petrolina, Pernambuco Brazil; Bahian School of Medicine and Public Health Salvador Bahia Brazil Bahian School of Medicine and Public Health, Salvador, Bahia, Brazil; São Rafael Hospital Salvador Bahia Brazil São Rafael Hospital, Salvador, Bahia, Brazil; Johns Hopkins Hospital Baltimore MD USA Johns Hopkins Hospital, Baltimore, MD, USA. Mailing Address: Nayane Carolina Pertile Salvioni • Rua Desembargador Eliseu Guilherme, 147, 3° subsolo, Paraíso. CEP: 04004-030, São Paulo, SP, Brazil. E-mail: nayanepertile@gmail.com

Authors’ contributions

Research creation and design:: Armstrong AC; Morais Júnior JC; Data acquisition: Morais Júnior JC; Salvioni NCP; Cardoso LS; Confessor CF; Silva AML; Lima DRV; Galdino Júnior APC; Data analysis and interpretation: Morais Júnior JC; Salvioni NCP; Cardoso LS; Armstrong AC; Statistical analysis: Armstrong AC; Writing: Morais Júnior JC; Critical revision for important intellectual content: Lima DRV; Silva AML; Lima J; Armstrong AC; Correia LCL

Conflict of interest

The authors have declared that they have no conflict of interest.

 17 12 2021 Oct-Dec 2020 33 4 1 7 14 1 2020 23 3 2020 9 7 2020 This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background

Stroke is prevalent worldwide, and early recognition of subclinical cardiovascular (CV) disease could predict a first ischemic stroke (IS) episode. Speckle-tracking echocardiography (STE) allows the detection of early subclinical myocardial dysfunction.

 Aim

To examine the association between myocardial deformation, evaluated by STE, and first episode of IS in a sample of otherwise healthy patients.

 Methods

We included individuals between 40–80 years old, with a first incidence of IS, with no known CV disease, matched to healthy controls by sex, age, and hypertension at a 1:2 ratio. STE was used to assess LV global longitudinal strain (GLS), and traditional echocardiography was performed. Univariate and multivariable analyses were performed to assess the relationship among stroke, CV risk factors, and echocardiography-derived parameters.

 Results

A total of 29 cases and 62 controls were included. The mean age of the patients was 60 ± 12 y/o, and 54% were males. Smoking was more prevalent in cases compared to controls (34% vs. 9%; p = 0.001), and there were no significant differences in the other examined risk factors. Cases had less myocardial deformation compared to controls (GLS: -16.7% ± 3.4% vs. -19.2 ± 2.8%; p < 0.001), and there was no significant difference regarding traditional echocardiography parameters. After adjusting for smoking and hyperlipidemia, GLS maintained an independent association with stroke (OR = 1.3; 95% CI, 1.1–1.6; p = 0.005). The area under the ROC curve for stroke significantly increased after adding GLS to smoking (0.65 to 0.78, p = 0.009).

 Conclusion

GLS has a consistent and independent association with a first IS episode in middle-aged adults with generally normal hearts. Therefore, GLS may be a useful risk marker in this population.

 Resumo Fundamento

O acidente vascular encefálico (AVE) é prevalente no mundo. Reconhecimento precoce da doença cardiovascular subclínica pode predizer um primeiro episódio de AVE isquêmico; o speckle tracking associado à ecocardiografia (STE) permite detecção precoce da disfunção miocárdica subclínica.

 Objetivo

Provar a associação entre deformação miocárdica avaliada pelo STE e primeiro episódio de AVE em indivíduos saudáveis.

 Método

Incluímos participantes entre 40-80 anos com primeiro episódio de AVE isquêmico sem cardiopatia conhecida, pareados por sexo, idade e hipertensão com grupo controle saudável na proporção 1:2. STE avaliou strain longitudinal (SL) do VE, e ecocardiografia tradicional foi realizada. Análises univariada e multivariada avaliaram as relações do AVE com fatores de risco cardiovasculares e parâmetros derivados da ecocardiografia.

 Resultado

29 casos e 62 controles foram incluídos. Média etária foi 60 ± 12 anos; 54% eram homens. Tabagismo foi mais prevalente em casos do que em controles (34% vs. 9%; p=0.001). Nenhum outro fator de risco evidenciou diferença estatística. Casos tiveram menor deformação miocárdica comparados aos controles (SL -16.7 ± 3.4% vs. -19.2 ± 2.8%; p < 0.001). Não houve diferença em relação aos parâmetros ecocardiográficos tradicionais. Após ajuste para tabagismo e hiperlipidemia, SL manteve-se independentemente associado com AVE (OR=1.3; 95% CI, 1.1 – 1.6; p=0.005). A área abaixo à curva ROC para AVE aumentou significativamente após adicionar SL ao tabagismo (0.65 para 0.78, respectivamente; p=0.009).

 Conclusão

SL tem independente associação com o primeiro episódio de AVE isquêmico em adultos de média idade com corações geralmente normais. SL pode ser potencial marcador de risco nesta população.

 Stroke Cardiovascular Disease Echocardiography Acidente Vascular Cerebral Doenças Cardiovasculares Ecocardiografia