Objective:

Describe incidence of neurogenic stress cardiomyopathy (NSC) in acute ischemic stroke (AIS) and determine if there is an association between leukocytosis and development of NSC.

Background:

NSC is a syndrome of cardiac impairment following an acute neurologic injury. Cardiac impairment is identified by reduced left ventricular ejection fraction (LVEF), ventricular wall motion abnormalities, and elevated cardiac troponin and brain natriuretic peptide (BNP). Limited studies have found troponin elevations in 17-20% of stroke patients, but NSC is not well described. Inflammation is one of the proposed potential mechanisms of stroke-induced cardiac injury. Inflammation in AIS may correlate with development of NSC, but this has not been well studied.

Design/Methods:

Retrospective review of 688 adult patients admitted to a single tertiary care center with AIS from 2018 to 2021. NSC was defined by at least one of the following: reduced LVEF, ventricular wall motion abnormalities, elevated troponin, or elevated BNP within first 24 hours of admission. Leukocytosis was defined as white blood cell (WBC) count > 12.0 x 10⁹/L.

Results:

NSC was observed in 267 (39%) of the 688 patients with AIS. Mean age was 67 years old and 46% female. Mean NIHSS in those with NSC was 10. Mean length of hospital stay was 8 days. Leukocytosis was observed 12% of patients with NSC and in 8% of patients without NSC. Mean WBC in patients with NSC was 8.63 x 10⁹/L. Mean WBC in patients without NSC was 8.07 x 10⁹/L. Analysis via two-tailed T-test revealed no significant difference between groups (p>0.5).

Conclusions:

We found a high incidence of NSC, when compared to previous reports. There was no statistically significant difference in leukocytosis between groups. Further research is needed to identify risk factors of NSC, including other markers of inflammation, that may better elucidate the underlying mechanism.