Skip to main content
Top
Published in: Clinical Research in Cardiology 8/2015

01-08-2015 | Original Paper

Prevalence and impact on outcome of electrocardiographic early repolarization patterns among stroke patients: a prospective observational study

Authors: Tobias Bobinger, Bernd Kallmünzer, Markus Kopp, Natalia Kurka, Martin Arnold, Max-Josef Hilz, Hagen B. Huttner, Stefan Schwab, Martin Köhrmann

Published in: Clinical Research in Cardiology | Issue 8/2015

Login to get access

Abstract

Background

Early repolarization pattern (ER) gained attention as a risk factor for ventricular arrhythmia and sudden cardiac death in the general population. While electrocardiographic abnormalities are frequent findings in stroke patients, data on ER pattern in this population are lacking.

Methods

We assessed the prevalence of ER pattern in consecutive acute stroke patients at a tertiary stroke center. Functional outcome after 90 days was analyzed to determine the effect of an ER pattern on mortality. Multivariate logistic regression analysis was used to identify factors associated with an ER pattern.

Results

Out of 1141 consecutive stroke patients 771 patients remained for analysis after application of exclusion criteria. ER was observed in 62 (8.04 %) patients. ER was more prevalent among subjects with intracerebral and subarachnoidal hemorrhage (13.0 %) than among patients with ischemic stroke (7.0 %; p = 0.024). Multiple regression analysis revealed QRS-duration (OR 0.972 95 % CI 0.950–0.994, p = 0.012), QT-duration (OR 1.009, 95 % CI 1.004–1.014, p = 0.001) and mechanical ventilation on admission (OR 0.320, 95 % CI 0.136–0.752, p = 0.009) as independent predictors for ER. Overall ER on admission was not associated with increased mortality at 3-month follow-up (ER 11.3 % vs. non-ER 9.2 %; p = 0.582).

Conclusions

ER is frequently found among patients with acute cerebrovascular events and is more prevalent in patients with hemorrhagic compared to ischemic events. Our study yields no evidence that ER is associated with worse outcome or mortality after stroke.
Appendix
Available only for authorised users
Literature
1.
go back to reference Klingelhofer J, Sander D (1997) Cardiovascular consequences of clinical stroke. Baillieres Clin Neurol 6:309–335PubMed Klingelhofer J, Sander D (1997) Cardiovascular consequences of clinical stroke. Baillieres Clin Neurol 6:309–335PubMed
2.
go back to reference Prosser J, MacGregor L, Lees KR, Diener HC, Hacke W, Davis S (2007) Predictors of early cardiac morbidity and mortality after ischemic stroke. Stroke 38:2295–2302PubMedCrossRef Prosser J, MacGregor L, Lees KR, Diener HC, Hacke W, Davis S (2007) Predictors of early cardiac morbidity and mortality after ischemic stroke. Stroke 38:2295–2302PubMedCrossRef
3.
go back to reference Christensen H, Boysen G, Johannesen HH (2004) Serum-cortisol reflects severity and mortality in acute stroke. J Neurol Sci 217:175–180PubMedCrossRef Christensen H, Boysen G, Johannesen HH (2004) Serum-cortisol reflects severity and mortality in acute stroke. J Neurol Sci 217:175–180PubMedCrossRef
4.
go back to reference Feibel JH, Hardy PM, Campbell RG, Goldstein MN, Joynt RJ (1977) Prognostic value of the stress response following stroke. JAMA J Am Med Assoc 238:1374–1376CrossRef Feibel JH, Hardy PM, Campbell RG, Goldstein MN, Joynt RJ (1977) Prognostic value of the stress response following stroke. JAMA J Am Med Assoc 238:1374–1376CrossRef
5.
go back to reference Soros P, Hachinski V (2012) Cardiovascular and neurological causes of sudden death after ischaemic stroke. Lancet Neurol 11:179–188PubMedCrossRef Soros P, Hachinski V (2012) Cardiovascular and neurological causes of sudden death after ischaemic stroke. Lancet Neurol 11:179–188PubMedCrossRef
6.
go back to reference Koppikar S, Baranchuk A, Guzman JC, Morillo CA (2013) Stroke and ventricular arrhythmias. Int J Cardiol 168:653–659PubMedCrossRef Koppikar S, Baranchuk A, Guzman JC, Morillo CA (2013) Stroke and ventricular arrhythmias. Int J Cardiol 168:653–659PubMedCrossRef
7.
go back to reference Tobias SL, Bookatz BJ, Diamond TH (1987) Myocardial damage and electrocardiographic changes in acute cerebrovascular hemorrhage: a report of three cases and review. Heart Lung J Crit Care 16:521–526 Tobias SL, Bookatz BJ, Diamond TH (1987) Myocardial damage and electrocardiographic changes in acute cerebrovascular hemorrhage: a report of three cases and review. Heart Lung J Crit Care 16:521–526
8.
go back to reference Micieli G, Cavallini A (2008) The autonomic nervous system and ischemic stroke: a reciprocal interdependence. Clin Auton Res 18:308–317PubMedCrossRef Micieli G, Cavallini A (2008) The autonomic nervous system and ischemic stroke: a reciprocal interdependence. Clin Auton Res 18:308–317PubMedCrossRef
11.
go back to reference Katsanos AH, Korantzopoulos P, Tsivgoulis G, Kyritsis AP, Kosmidou M, Giannopoulos S (2013) Electrocardiographic abnormalities and cardiac arrhythmias in structural brain lesions. Int J Cardiol 167:328–334PubMedCrossRef Katsanos AH, Korantzopoulos P, Tsivgoulis G, Kyritsis AP, Kosmidou M, Giannopoulos S (2013) Electrocardiographic abnormalities and cardiac arrhythmias in structural brain lesions. Int J Cardiol 167:328–334PubMedCrossRef
12.
go back to reference Cropp GJ, Manning GW (1960) Electrocardiographic changes simulating myocardial ischemia and infarction associated with spontaneous intracranial hemorrhage. Circulation 22:25–38PubMedCrossRef Cropp GJ, Manning GW (1960) Electrocardiographic changes simulating myocardial ischemia and infarction associated with spontaneous intracranial hemorrhage. Circulation 22:25–38PubMedCrossRef
13.
go back to reference Byer E, Ashman R, Toth LA (1947) Electrocardiograms with large, upright T waves and long Q-T intervals. Am Heart J 33:796–806PubMedCrossRef Byer E, Ashman R, Toth LA (1947) Electrocardiograms with large, upright T waves and long Q-T intervals. Am Heart J 33:796–806PubMedCrossRef
14.
go back to reference Fentz V, Gormsen J (1962) Electrocardiographic patterns in patients with cerebrovascular accidents. Circulation 25:22–28PubMedCrossRef Fentz V, Gormsen J (1962) Electrocardiographic patterns in patients with cerebrovascular accidents. Circulation 25:22–28PubMedCrossRef
15.
go back to reference Khechinashvili G, Asplund K (2002) Electrocardiographic changes in patients with acute stroke: a systematic review. Cerebrovasc Dis 14:67–76PubMedCrossRef Khechinashvili G, Asplund K (2002) Electrocardiographic changes in patients with acute stroke: a systematic review. Cerebrovasc Dis 14:67–76PubMedCrossRef
16.
go back to reference Goldstein DS (1979) The electrocardiogram in stroke: relationship to pathophysiological type and comparison with prior tracings. Stroke 10:253–259PubMedCrossRef Goldstein DS (1979) The electrocardiogram in stroke: relationship to pathophysiological type and comparison with prior tracings. Stroke 10:253–259PubMedCrossRef
17.
go back to reference Kallmunzer B, Breuer L, Kahl N, Bobinger T, Raaz-Schrauder D, Huttner HB et al (2012) Serious cardiac arrhythmias after stroke: incidence, time course, and predictors–a systematic, prospective analysis. Stroke 43:2892–2897PubMedCrossRef Kallmunzer B, Breuer L, Kahl N, Bobinger T, Raaz-Schrauder D, Huttner HB et al (2012) Serious cardiac arrhythmias after stroke: incidence, time course, and predictors–a systematic, prospective analysis. Stroke 43:2892–2897PubMedCrossRef
18.
go back to reference Christensen H, Fogh Christensen A, Boysen G (2005) Abnormalities on ECG and telemetry predict stroke outcome at 3 months. J Neurol Sci 234:99–103PubMedCrossRef Christensen H, Fogh Christensen A, Boysen G (2005) Abnormalities on ECG and telemetry predict stroke outcome at 3 months. J Neurol Sci 234:99–103PubMedCrossRef
19.
go back to reference Dogan A, Tunc E, Ozturk M, Kerman M, Akhan G (2004) Electrocardiographic changes in patients with ischaemic stroke and their prognostic importance. Int J Clin Pract 58:436–440PubMedCrossRef Dogan A, Tunc E, Ozturk M, Kerman M, Akhan G (2004) Electrocardiographic changes in patients with ischaemic stroke and their prognostic importance. Int J Clin Pract 58:436–440PubMedCrossRef
20.
go back to reference Providencia R, Barra S, Paiva L (2013) Atrial fibrillation, elevated troponin, ischemic stroke and adverse outcomes: understanding the connection. Clin Res Cardiol Off J Ger Card Soc 102:701–711CrossRef Providencia R, Barra S, Paiva L (2013) Atrial fibrillation, elevated troponin, ischemic stroke and adverse outcomes: understanding the connection. Clin Res Cardiol Off J Ger Card Soc 102:701–711CrossRef
21.
go back to reference Haissaguerre M, Derval N, Sacher F, Jesel L, Deisenhofer I, de Roy L et al (2008) Sudden cardiac arrest associated with early repolarization. N Engl J Med 358:2016–2023PubMedCrossRef Haissaguerre M, Derval N, Sacher F, Jesel L, Deisenhofer I, de Roy L et al (2008) Sudden cardiac arrest associated with early repolarization. N Engl J Med 358:2016–2023PubMedCrossRef
22.
go back to reference Sinner MF, Reinhard W, Muller M, Beckmann BM, Martens E, Perz S, et al. (2010) Association of early repolarization pattern on ECG with risk of cardiac and all-cause mortality: a population-based prospective cohort study (MONICA/KORA). PLoS Med 7: e1000314 Sinner MF, Reinhard W, Muller M, Beckmann BM, Martens E, Perz S, et al. (2010) Association of early repolarization pattern on ECG with risk of cardiac and all-cause mortality: a population-based prospective cohort study (MONICA/KORA). PLoS Med 7: e1000314
23.
go back to reference Kallmunzer B, Kuramatsu J, Breuer L, Engelhorn T, Kohrmann M (2011) Early repolarisation syndrome and ischemic stroke: is there a link? Cerebrovasc Dis 31:414–415PubMedCrossRef Kallmunzer B, Kuramatsu J, Breuer L, Engelhorn T, Kohrmann M (2011) Early repolarisation syndrome and ischemic stroke: is there a link? Cerebrovasc Dis 31:414–415PubMedCrossRef
24.
go back to reference Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM et al (2013) Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 44:870–947PubMedCrossRef Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM et al (2013) Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 44:870–947PubMedCrossRef
25.
26.
go back to reference European Stroke Organisation (ESO) Executive Committee (2008) Guidelines for management of ischaemic stroke and transient ischaemic attack. Cerebrovasc Dis 25: 457–507 European Stroke Organisation (ESO) Executive Committee (2008) Guidelines for management of ischaemic stroke and transient ischaemic attack. Cerebrovasc Dis 25: 457–507
27.
go back to reference Laufs U, Hoppe UC, Rosenkranz S, Kirchhof P, Bohm M, Diener HC et al (2010) Cardiological evaluation after cerebral ischaemia : consensus statement of the Working Group Heart and Brain of the German Cardiac Society-Cardiovascular Research (DGK) and the German Stroke Society (DSG). Clin Res Cardiol Off J Ger Cardiac Soc 99:609–625CrossRef Laufs U, Hoppe UC, Rosenkranz S, Kirchhof P, Bohm M, Diener HC et al (2010) Cardiological evaluation after cerebral ischaemia : consensus statement of the Working Group Heart and Brain of the German Cardiac Society-Cardiovascular Research (DGK) and the German Stroke Society (DSG). Clin Res Cardiol Off J Ger Cardiac Soc 99:609–625CrossRef
28.
go back to reference Sulter G, Steen C, De Keyser J (1999) Use of the Barthel index and modified Rankin scale in acute stroke trials. Stroke 30:1538–1541PubMedCrossRef Sulter G, Steen C, De Keyser J (1999) Use of the Barthel index and modified Rankin scale in acute stroke trials. Stroke 30:1538–1541PubMedCrossRef
29.
go back to reference O’Keefe JH (2002) The complete guide to ECGs. 2nd ed. Royal Physicians Press, Oak O’Keefe JH (2002) The complete guide to ECGs. 2nd ed. Royal Physicians Press, Oak
30.
go back to reference Villa A, Bacchetta A, Milani O, Omboni E (2001) QT interval prolongation as predictor of early mortality in acute ischemic stroke patients. Am J Emerg Med 19:332–333PubMedCrossRef Villa A, Bacchetta A, Milani O, Omboni E (2001) QT interval prolongation as predictor of early mortality in acute ischemic stroke patients. Am J Emerg Med 19:332–333PubMedCrossRef
31.
go back to reference Tikkanen JT, Junttila MJ, Anttonen O, Aro AL, Luttinen S, Kerola T et al (2011) Early repolarization: electrocardiographic phenotypes associated with favorable long-term outcome. Circulation 123:2666–2673PubMedCrossRef Tikkanen JT, Junttila MJ, Anttonen O, Aro AL, Luttinen S, Kerola T et al (2011) Early repolarization: electrocardiographic phenotypes associated with favorable long-term outcome. Circulation 123:2666–2673PubMedCrossRef
32.
go back to reference Tikkanen JT, Anttonen O, Junttila MJ, Aro AL, Kerola T, Rissanen HA et al (2009) Long-term outcome associated with early repolarization on electrocardiography. N Engl J Med 361:2529–2537PubMedCrossRef Tikkanen JT, Anttonen O, Junttila MJ, Aro AL, Kerola T, Rissanen HA et al (2009) Long-term outcome associated with early repolarization on electrocardiography. N Engl J Med 361:2529–2537PubMedCrossRef
33.
go back to reference Tikkanen JT, Huikuri HV (2013) Early repolarization ECG pattern in the Finnish general population. J Electrocardiol 46:439–441PubMedCrossRef Tikkanen JT, Huikuri HV (2013) Early repolarization ECG pattern in the Finnish general population. J Electrocardiol 46:439–441PubMedCrossRef
34.
go back to reference Walsh JA 3rd, Ilkhanoff L, Soliman EZ, Prineas R, Liu K, Ning H et al (2013) Natural history of the early repolarization pattern in a biracial cohort: CARDIA (Coronary Artery Risk Development in Young Adults) Study. J Am Coll Cardiol 61:863–869PubMedCentralPubMedCrossRef Walsh JA 3rd, Ilkhanoff L, Soliman EZ, Prineas R, Liu K, Ning H et al (2013) Natural history of the early repolarization pattern in a biracial cohort: CARDIA (Coronary Artery Risk Development in Young Adults) Study. J Am Coll Cardiol 61:863–869PubMedCentralPubMedCrossRef
35.
go back to reference Furukawa Y, Yamada T, Morita T, Iwasaki Y, Kawasaki M, Kikuchi A et al (2013) Early repolarization pattern associated with sudden cardiac death: long-term follow-up in patients with chronic heart failure. J Cardiovasc Electrophysiol 24:632–639PubMedCrossRef Furukawa Y, Yamada T, Morita T, Iwasaki Y, Kawasaki M, Kikuchi A et al (2013) Early repolarization pattern associated with sudden cardiac death: long-term follow-up in patients with chronic heart failure. J Cardiovasc Electrophysiol 24:632–639PubMedCrossRef
36.
go back to reference Hajhosseiny R, Rajani R, Khavandi K, Sebag FA, Mashayekhi S, Wright M et al (2013) The prevalence of electrocardiographic early repolarization in an adult cohort with chronic kidney disease and its impact upon all-cause mortality and progression to dialysis. Front Physiol 4:127PubMedCentralPubMedCrossRef Hajhosseiny R, Rajani R, Khavandi K, Sebag FA, Mashayekhi S, Wright M et al (2013) The prevalence of electrocardiographic early repolarization in an adult cohort with chronic kidney disease and its impact upon all-cause mortality and progression to dialysis. Front Physiol 4:127PubMedCentralPubMedCrossRef
37.
go back to reference Noseworthy PA, Weiner R, Kim J, Keelara V, Wang F, Berkstresser B, et al. (2011) Early repolarization pattern in competitive athletes: clinical correlates and the effects of exercise training. Circ Arrhythm Electrophysiol 4: 432–440 Noseworthy PA, Weiner R, Kim J, Keelara V, Wang F, Berkstresser B, et al. (2011) Early repolarization pattern in competitive athletes: clinical correlates and the effects of exercise training. Circ Arrhythm Electrophysiol 4: 432–440
38.
go back to reference Rollin A, Maury P, Bongard V, Sacher F, Delay M, Duparc A et al (2012) Prevalence, prognosis, and identification of the malignant form of early repolarization pattern in a population-based study. Am J Cardiol 110:1302–1308PubMedCrossRef Rollin A, Maury P, Bongard V, Sacher F, Delay M, Duparc A et al (2012) Prevalence, prognosis, and identification of the malignant form of early repolarization pattern in a population-based study. Am J Cardiol 110:1302–1308PubMedCrossRef
39.
go back to reference Uberoi A, Jain NA, Perez M, Weinkopff A, Ashley E, Hadley D et al (2011) Early repolarization in an ambulatory clinical population. Circulation 124:2208–2214PubMedCrossRef Uberoi A, Jain NA, Perez M, Weinkopff A, Ashley E, Hadley D et al (2011) Early repolarization in an ambulatory clinical population. Circulation 124:2208–2214PubMedCrossRef
40.
go back to reference Wu SH, Lin XX, Cheng YJ, Qiang CC, Zhang J (2013) Early repolarization pattern and risk for arrhythmia death: a meta-analysis. J Am Coll Cardiol 61:645–650PubMedCrossRef Wu SH, Lin XX, Cheng YJ, Qiang CC, Zhang J (2013) Early repolarization pattern and risk for arrhythmia death: a meta-analysis. J Am Coll Cardiol 61:645–650PubMedCrossRef
41.
go back to reference Greenfield JC Jr, Rembert JC (2013) The prevalence of lateral lead early repolarization in otherwise normal electrocardiograms as a function of age. J Electrocardiol 46:334–335PubMedCrossRef Greenfield JC Jr, Rembert JC (2013) The prevalence of lateral lead early repolarization in otherwise normal electrocardiograms as a function of age. J Electrocardiol 46:334–335PubMedCrossRef
43.
go back to reference Benito B, Guasch E, Rivard L, Nattel S (2010) Clinical and mechanistic issues in early repolarization of normal variants and lethal arrhythmia syndromes. J Am Coll Cardiol 56:1177–1186PubMedCrossRef Benito B, Guasch E, Rivard L, Nattel S (2010) Clinical and mechanistic issues in early repolarization of normal variants and lethal arrhythmia syndromes. J Am Coll Cardiol 56:1177–1186PubMedCrossRef
Metadata
Title
Prevalence and impact on outcome of electrocardiographic early repolarization patterns among stroke patients: a prospective observational study
Authors
Tobias Bobinger
Bernd Kallmünzer
Markus Kopp
Natalia Kurka
Martin Arnold
Max-Josef Hilz
Hagen B. Huttner
Stefan Schwab
Martin Köhrmann
Publication date
01-08-2015
Publisher
Springer Berlin Heidelberg
Published in
Clinical Research in Cardiology / Issue 8/2015
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-015-0831-6

Other articles of this Issue 8/2015

Clinical Research in Cardiology 8/2015 Go to the issue