From the Guidelines
Cardiac hypokinesis significantly increases the risk of stroke, with an estimated 18% increment in stroke risk for every 5% decline in ejection fraction (EF) 1. The relationship between cardiac hypokinesis and stroke risk is well-established, particularly in patients with left ventricular systolic dysfunction.
- The SAVE study found that patients with an EF of 29% to 35% had a stroke rate of 0.8% per year, while those with an EF of 28% had a stroke rate of 1.7% per year 1.
- A retrospective analysis of the SOLVD trial data showed a 58% increase in risk of thromboembolic events for every 10% decrease in EF among women, although no significant increase was found in men 1. The use of anticoagulation therapy, such as warfarin, may be considered to reduce the risk of stroke in patients with cardiac hypokinesis, although the evidence is not conclusive 1.
- The WASH and WATCH trials did not demonstrate a significant reduction in stroke risk with warfarin or antiplatelet therapy, although other studies have shown that warfarin can reduce the risk of stroke by 40-55% compared to placebo 1.
- Aspirin has also been shown to reduce the stroke rate by 20% in patients with cardiac hypokinesis 1. Regular monitoring of cardiac function, blood pressure control, and lifestyle modifications are also essential in reducing the risk of stroke in patients with cardiac hypokinesis.
- Blood pressure should be controlled to below 130/80 mmHg using medications like ACE inhibitors or ARBs.
- Lifestyle modifications, including a low-sodium diet, regular moderate exercise, smoking cessation, and limiting alcohol consumption, can further reduce stroke risk.
From the Research
Risk of Stroke due to Cardiac Hypokinesis
The risk of stroke due to cardiac hypokinesis, or reduced heart movement, is a significant concern in patients with heart failure or left ventricular dysfunction.
- Cardiac hypokinesis can lead to blood stasis and increased risk of thromboembolic events, including stroke 2.
- Left ventricular wall motion abnormalities, which can occur in patients with cardiac hypokinesis, predispose to local thrombosis and increase the risk of stroke 2.
- The use of anticoagulation therapy, such as novel oral anticoagulants (NOACs), can help reduce the risk of stroke in patients with cardiac hypokinesis and atrial fibrillation 3, 2, 4.
- However, the effectiveness of anticoagulation therapy in preventing stroke in patients with cardiac hypokinesis and sinus rhythm is less clear, and further research is needed to determine the best approach 2, 5.
Factors Influencing Stroke Risk
Several factors can influence the risk of stroke in patients with cardiac hypokinesis, including:
- Left ventricular ejection fraction: Patients with reduced left ventricular ejection fraction are at increased risk of stroke 2, 5.
- Presence of left ventricular thrombus: The presence of a left ventricular thrombus increases the risk of stroke, and anticoagulation therapy is recommended to reduce this risk 5.
- Wall motion abnormalities: Wall motion abnormalities can increase the risk of stroke, but the effectiveness of anticoagulation therapy in preventing stroke in these patients is unclear 2, 5.
Treatment Options
Treatment options for preventing stroke in patients with cardiac hypokinesis include:
- Anticoagulation therapy: NOACs, such as apixaban, dabigatran, and rivaroxaban, can help reduce the risk of stroke in patients with cardiac hypokinesis and atrial fibrillation 3, 2, 4.
- Antiplatelet therapy: Antiplatelet agents, such as aspirin and clopidogrel, may be used to prevent stroke in patients with cardiac hypokinesis, but their effectiveness is less clear 6.
- Mechanical thrombectomy: Mechanical thrombectomy may be considered as a therapeutic alternative to intravenous thrombolysis in patients with acute ischemic stroke due to large-vessel occlusion and recent myocardial infarction 5.