Echocardiographic abnormalities in young versus older adult stroke cases

Background: There is an increasing prevalence of stroke in the young adults as well as older adults in general. Cardiovascular risks are a significant predisposition to occurrence of stroke in both age groups. Various cardiac abnormalities are present in stroke patients either as risk factors or as complications. A relationship exists between these cardiac abnormalities and the prevalence, morbidity and mortality from stroke. The changing pattern of the cardiovascular risk factors among these groups of patients may contribute to a changing pattern of cardiac and echocardiographic abnormalities in stroke patients. Objective: The aim of the study was to investigate the profile as well as prevalence of various echocardiographic abnormalities in young versus older adult stroke patients of the different subtypes of stroke. Method: Descriptive cross sectional and comparative study was done. 180 subjects comprising of 90 young(less than 45years) and 90 older (45years and above) adult stroke patients were recruited for this study. Echocardiography was done for the patients. Echocardiographic abnormalities were compared among the young versus the older groups using chi-square and t-test tests when necessary. Results: Mean age in the young and older stroke patients were 40.23 ± 2.75 and 65.77 ± 12.34 years respectively. Male to Female ratio was 1.6: 1 among the older group and 1.4: 1 among the young group. Ischaemic stroke was the commonest subtype of stroke in both groups of patients (54.4% in the young and 68.9% in the older group of patients). Intracerebralhaemorrhage and subarachnoid haemorrhage were present in 37.8% and 7.8% respectively in the young while 26.7% and 4.4% of the older group had intracerebral and subarachnoid haemorrhage respectively. Echocardiographic left ventricular hypertrophy was also the commonest structural abnormality on transthoracic echocardiography in both groups of patients (52.3% in the young versus 47.1%in the older group), and the difference in prevalence was not significant. Left ventricular systolic dysfunction was significantly more in the older patients than the young (21.1% versus 6.7% χ2=7.850, p=0.005). Left ventricular diastolic dysfunction was slightly more in the older group (86.7%), compared with the young (75.6%). This difference was however not significant (χ2=6.759, P=0.08). The commonest pattern of cardiac diagnosis was hypertensive heart disease in both groups of patients (68.9 versus 65.5%).Others were valvular heart disease (6.7% both groups), ischaemic heart disease (2.2% and 5.5% in the young and old respectively), pericardial diseases (2.2% and 5.5% in the young and old respectively) dilated cardiomyopathy (1.1%) and hypertrophic cardiomyopathy (1.1%) both in the older group and left atrial myxoma (1.1%) in the young group. Conclusion: Transthoracic echocardiographic structural and functional abnormalities were largely similar among both age groups with slight differences noted. Left ventricular systolic dysfunction was significantly more on echocardiography among the older group of patients. It is therefore important to screen adult patients with stroke irrespective of the age at presentation.