A Novel Approach to Assessing the Severity of Acute Stroke and Neurological Deficits in Patients with Acute Ischemic Stroke Using Myocardial Work Echocardiography

Background: We aimed to evaluate the feasibility and performance of myocardial work echocardiography in assessing the severity of acute stroke and neurological deficits in patients with acute ischemic stroke.

Methods: A total of 176 patients were examined by echocardiography within 24-48 hours of symptom onset with the measurement of global and regional myocardial work. The National Institutes of Health Stroke Scale score of each patient was documented.

Results: With the increase of the National Institutes of Health Stroke Scale score, myocardial constructive work or positive work decreased (P <.05), while myocardial wasted work or negative work increased (P <.05). Except for global constructive work, global positive work, and global systolic constructive work, other myocardial work parameters all correlated with the National Institutes of Health Stroke Scale score
(P  < .05). Moreover, global wasted work, global negative work and global systolic wasted work had the strongest correlation with the National Institutes of Health Stroke Scale score (P  < .001).Among these parameters, the ratio of global positive work/global negative work had the largest area (0.969, 0.938-1.001) under receiver operating characteristic curve in discriminating if the National Institutes of Health Stroke Scale score >15 or not. The optimal cutoff value was 3.89, with a sensitivity of 100%, a specificity of 93.0%, a positive predictive value of 84.9%, a negative predictive value of 100%, and an accuracy of 95.7%.

Conclusion: Noninvasive myocardial work is highly competent in assessing the severity of acute stroke and neurological deficits, which can be used as a powerful supplement to the conventional scoring system.