Abnormal Left Ventricular Geometry in Lacunar Stroke: Spectrum, Prevalence and Prognostic Implications in the SPS3 Trial (S15.001)

OBJECTIVE Define the spectrum of left ventricular geometry (LVG) and its association with baseline clinical and neuroradiological features and outcomes in patients with lacunar infarcts. BACKGROUND The role of structural heart disease in lacunar stroke patients is not well defined. Echocardiography is frequently used to ascertain stroke mechanism. Though this modality rarely identifies a cardioembolic mechanism in lacunar patients, the spectrum, prevalence and prognostic implications of abnormal LVG in these patients is unknown. DESIGN/METHODS Data is from the Secondary Prevention of Small Subcortical Strokes (SPS3) trial. Patients with recent symptomatic lacunar infarcts were randomized to higher (130-149 mmHg) vs. lower (<130 mmHg) blood pressure targets and single vs. dual antiplatelet (AP) therapy. LVG on transthoracic echocardiography (TTE) was classified as normal (N), concentric remodeling (CR), concentric hypertrophy (CH), or eccentric hypertrophy (EH) using the Devereaux formula. Bi- and multinomial multivariable (MV) logistic regression models identified independent characteristics. RESULTS 1961 subjects (mean (sd) age 63(11); 64% male) were followed a mean of 3.5(1.9) years. N LVG was present in 23%, CH 31%, CR 39%, EH 7%. Abnormal LVG was independently associated with sex, diabetes, history and severity of hypertension, race-ethnicity and decreased renal function. Subjects with CH vs. N LVG were more likely to have advanced neurological manifestations of small vessel disease (SVD) including previous subcortical infarcts (MV OR1.9, 95% CI 1.5-2.5) and white matter hypertensities (MV OR mod 1.8, CI 1.3-2.5; severe 1.9, 1.3-2.7 vs. none-mild). LVG remained predictive of stroke recurrence after adjusting for assigned treatments and risk factors (HR for CR vs. N LVG 1.7, 95% CI 1.1-2.7). There was no interaction between LVG and AP (p=0.5) or BP target (0.9). CONCLUSIONS LVG consistent with chronic hypertensive changes is present in a large subset of lacunar stroke patients, is associated with distinct risk factors, and correlates with neuroradiological manifestations of SVD. TTE in lacunar patients yields valuable information with regards to severity of small vessel disease and prognosis. Disclosure: Dr. Field has received personal compensation in an editorial capacity for Postgraduate Medicine. Dr. Pearce has nothing to disclose. Dr. Chan-Smyth has nothing to disclose. Dr. De has nothing to disclose. Dr. Gubitz has nothing to disclose. Dr. Phillips has nothing to disclose. Dr. Hart has received personal compensation for activities with Sanofi-Aventis Pharmaceuticals Inc., and Bristol-Myers Squibb Co. Dr. Benavente has received personal compensation in an editorial capacity for Bayer Pharmaceuticals Corporation and Osuka. Dr. Benavente has received research support from Sanofi-Aventis Pharmaceuticals, Inc.