Invited Speaker Australian and New Zealand Stroke Organisation Conference 2025

Systematic review and meta-analysis of risk of cardiac outcomes following embolic stroke of undetermined source (122911)

Nathalie Launder 1 , Chloe Mutimer 2 , Chushuang Chen 3 , Louise Segan 4 , Hannah Johns 1 , Mark Parsons 3 , Vignan Yogendrakumar 1 5 , Leonid Churilov 1
  1. Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
  2. Department of Neurology & Melbourne Brain Centre @ RMH, The Royal Melbourne Hospital, Parkville, VIC, Australia
  3. Department of Neurology, University of New South Wales, Liverpool, NSW, Australia
  4. Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
  5. The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada

Background/Aims: Patients who experience an ischaemic stroke have an increased risk of post-stroke cardiac outcomes.1-4 Approximately 30-40% of ischaemic strokes have no identifiable cause5 and are called embolic stroke of undetermined source (ESUS; aka cryptogenic stroke). Despite their prevalence little is known about risks of cardiac outcomes following ESUS.6 This review aims to estimate prevalences, annual incidence rates, cumulative incidences and hazards following ESUS up to 10 years after index ESUS, of major adverse cardiac events (MACE composite outcome and its components) as well as recurrent stroke.

Methods: The review was prospectively registered in PROSPERO (CRD420250655906). Databases MEDLINE and Embase were searched from inception through to 18 March 2025. Included studies were randomised controlled studies, cohort studies and cross-sectional studies reporting cardiac outcomes post-ESUS with at least one-year of follow-up. Study screening, data extraction, and quality and bias assessment are being completed in duplicate by two independent reviewers.

Results: 1587 studies were identified from the search. Title and abstract screening resulted in 378 studies for full text screening. Outcome data will be pooled using random-effects meta-analysis to estimate prevalences, annual incidence rates, cumulative incidences and hazards of outcomes, as appropriate. The results will be presented by study design and outcome measures.

Conclusion: This is an important clinical and scientific question, as further investigation will assist clinical decision making around treatment referral, enable better communication of cardiac risks post-ESUS and will assist in the design of secondary prevention trials to reduce future ESUS burden.

  1. 1. Wang L, Ma L, Ren C, et al. Stroke–heart syndrome: current progress and future outlook. Journal of Neurology. 2024/08/01 2024;271(8):4813-4825. doi:10.1007/s00415-024-12480-4
  2. 2. Hoad KL, Jones H, Miller G, Abdul-Rahim AH, Lip GYH, Buckley BJR. Stroke-heart syndrome: Incidence and clinical outcomes of cardiac complications following intracerebral haemorrhage. European Stroke Journal. 2024:23969873241264115. doi:10.1177/23969873241264115
  3. 3. Scheitz JF, Sposato LA, Schulz‐Menger J, Nolte CH, Backs J, Endres M. Stroke–Heart Syndrome: Recent Advances and Challenges. Journal of the American Heart Association. 2022/09/06 2022;11(17):e026528. doi:10.1161/JAHA.122.026528
  4. 4. Buckley BJR, Harrison SL, Hill A, Underhill P, Lane DA, Lip GYH. Stroke-Heart Syndrome: Incidence and Clinical Outcomes of Cardiac Complications Following Stroke. Stroke. 2022/05/01 2022;53(5):1759-1763. doi:10.1161/STROKEAHA.121.037316
  5. 5. Yaghi S, Bernstein RA, Passman R, Okin PM, Furie KL. Cryptogenic Stroke. Circulation Research. 2017/02/03 2017;120(3):527-540. doi:10.1161/CIRCRESAHA.116.308447
  6. 6. Boulanger M, Béjot Y, Rothwell PM, Touzé E. Long‐Term Risk of Myocardial Infarction Compared to Recurrent Stroke After Transient Ischemic Attack and Ischemic Stroke: Systematic Review and Meta‐Analysis. Journal of the American Heart Association. 2018;7(2):e007267. doi:10.1161/JAHA.117.007267