Left ventricular dysfunction in acute ischaemic stroke

Cardioactive neurohormonal regulation has been described in acute cerebrovascular accidents (CVA). Patients with CVA are more prone to cardiac arrhythmia. The latter phenomenon could be explained as a possible effect of neurohormonal regulation on myocardial kinetics and function. Inaccuracy inherent to M-mode and 2-dimentional quantitative echocardiographic assessment has limited its use in monitoring the minute changes in cardiac volumes and function that could accompany neurohormonal regulation. We hypothesised that neurohormonal regulation following acute ischaemic stroke (AIS) causes alteration to left ventricular volumes and function. We studied patients with acute ischaemic stroke using NT–pro-BNP blood assays on days 1 and 5 after admission to Gosford Hospital Stroke Unit. Patients were submitted to 3-dimentional (3-D) echocardiographic assessment using Phillips Sonos 7500 Equipment. End diastolic volume (EDV), end systolic volume (ESV), stroke volume (SV) and ejection fraction (EF) were measured on presentation and days 3–5 following admission. The echocardiographic images were analysed using Phillips Q Lab Software. NT–pro-BNP level at presentation (mean ± S.E.) was 1027 ± 429 pg/ml (N = 14) which was higher than day 5 (535 ± 215 pg/ml, N = 14, p < 0.5). Day 1 EDV, ESV and SV were 87 ± 6 ml, 44 ± 5 ml and 48 ± 3 ml, respectively (N = 21). Day 1 EF was 55 ± 3 (N = 21). Days 3–5 EDV, ESV and SV were 90 ± 7 ml, 43 ± 6 ml and 53 ± 4 ml, respectively (N = 21). Days 3–5 EF was 58 ± 4 (N = 21). The results demonstrate a trend towards a reduction in EF and SV in the acute post-AIS phase associated with evidence of neurohormonal regulation. The role of BNP in altering myocardial kinetics in early post-AIS phase deserves further investigation and needs to be viewed in the context of interaction between different neurohormones including catecholamines.