Electrocardiographic predictors of mortality in acute stroke

ABSTRACT

The study was done to see if ECG changes in acute stroke could be used as predictor of in-hospital mortality. Cross-Sectional study done at the Department of Emergency and Medicine Nishtar Hospital Multan, from April 2003 to August 2005. Two hundred patients with acute stroke who presented within 48-hours of the onset of neurological symptoms, were enrolled in the study, irrespective of the co morbid conditions like hypertension, diabetes mellitus, valvular heart disease, coronary artery disease and cardiomyopathy. A non-contrast computerized tomographic scan [CT Scan] of the brain and a 12-lead ECG were recorded at the time of admission to define the stroke type and to determine the ECG variables. Follow-up of the patients was done during their stay in the Medical ward to calculate in hospital mortality. The ECG variables were categorized as, disturbances of heart rate and rhythm, ischemic changes and heart rate corrected QT interval [QTc interval].They were correlated with the death during the hospital stay, by analyzing the data using SPSS-10 version for statistical analysis. Majority of the patients had ischemic stroke, but mortality was higher with hemorrhagic stroke. ECG changes due to variations in heart rate and rhythm were frequent but less helpful than ischemic changes and QTc alterations, in predicting in hospital deaths due to stroke. Hospital mortality in stroke patients is mostly of cardiac origin. ECG changes resulting from QTc prolongation, ischemic changes, and rhythm disturbances were most helpful in predicting the prognosis