In a cohort of patients without known heart disease and noncardioembolic AIS, poststroke cardiac findings were more common in men, particularly nonsustained ventricular tachycardia and polymorphic ventricular extrasystoles.
Key Findings
Results
Men had significantly higher odds of nonsustained ventricular tachycardia within 1 year after noncardioembolic ischemic stroke compared with women.
Odds ratio of 3.97 (95% CI, 1.14–13.86; P=0.031) for men versus women
Finding was consistent after multivariable adjustment for age, antihypertensive and lipid-lowering therapy, hypertension, diabetes, hyperlipidemia, and smoking
Study included 673 patients with noncardioembolic AIS and no evidence of previous cardiac disease
Cohort was 39% women with mean age of 61.2 years
Results
Men had significantly higher odds of first-degree atrioventricular block within 1 year after noncardioembolic ischemic stroke compared with women.
Odds ratio of 5.71 (95% CI, 1.48–22.01; P=0.013) for men versus women
Finding remained consistent after multivariable adjustment
Evaluated through standard cardiologic workup including 24-hour telemetry, 48-hour Holter ECG, and electronic health record review of cardiology consultations within 1 year
Results
Men had significantly higher odds of bradycardia within 1 year after noncardioembolic ischemic stroke compared with women.
Odds ratio of 3.40 (95% CI, 1.50–7.67; P=0.003) for men versus women
Finding was consistent after multivariable adjustment
Cardiac evaluation included 24-hour in-hospital telemetry, 24-hour blood pressure monitoring, echocardiography, and 48-hour Holter ECG for all patients
Results
Men had significantly higher odds of polymorphic ventricular extrasystoles within 1 year after noncardioembolic ischemic stroke compared with women.
Odds ratio of 2.61 (95% CI, 1.43–4.74; P=0.002) for men versus women
This was among the most statistically robust findings in the study
Finding was consistent after multivariable adjustment
Polymorphic ventricular extrasystoles were identified alongside nonsustained ventricular tachycardia as particularly notable sex-differentiated findings
Methods
The study screened 7113 patients with a first cerebrovascular event and identified 673 eligible patients with noncardioembolic AIS and no prior cardiac disease for inclusion.
Patients were screened from December 2013 to March 2021 at a tertiary stroke center
39% of the included cohort were women; mean age was 61.2 years
All included patients had noncardioembolic AIS as the stroke etiology and no evidence of previous cardiac disease
Electronic health records were reviewed for cardiology consultations and testing including ECG, echocardiography, coronary computed tomographic angiography, cardiac magnetic resonance imaging, and myocardial perfusion single-photon emission computed tomography within 1 year after the index event
Conclusions
The authors characterize their findings as hypothesis-generating observations that support further investigation into sex-informed poststroke cardiac evaluation.
The study was a single-center cohort design, which the authors acknowledge as a limitation implied by their characterization of findings as 'hypothesis-generating'
Multivariable binary logistic regression models were adjusted for age, antihypertensive and lipid-lowering therapy, hypertension, diabetes, hyperlipidemia, and smoking
The findings reflect bidirectional brain-heart interactions occurring after AIS even in patients without prior heart disease
Authors conclude these results 'support further investigation into sex-informed poststroke cardiac evaluation'
What This Means
This research suggests that after a certain type of stroke (noncardioembolic ischemic stroke) in people with no prior heart disease, men are significantly more likely than women to develop newly detected heart rhythm and conduction problems within the following year. Specifically, men were roughly 4 times more likely to have episodes of rapid ventricular heart rhythms (nonsustained ventricular tachycardia), about 5.7 times more likely to have a slowing of electrical conduction between heart chambers (first-degree atrioventricular block), about 3.4 times more likely to have an abnormally slow heart rate (bradycardia), and about 2.6 times more likely to have irregular heartbeats originating from multiple spots in the ventricles (polymorphic ventricular extrasystoles). These differences remained even after accounting for other risk factors like high blood pressure, diabetes, and smoking.
The study followed 673 patients from a large tertiary stroke center over nearly a decade, all of whom received a standardized cardiac workup after their stroke, including heart monitors, blood pressure monitoring, and echocardiography, as well as ongoing cardiology follow-up for up to one year. The fact that these cardiac abnormalities appeared in people who had no known heart disease before their stroke points to the well-recognized but not fully understood connection between the brain and the heart — where brain injury can trigger or unmask heart problems.
This research suggests that the heart consequences of stroke may differ meaningfully between men and women, though the authors emphasize these are preliminary, hypothesis-generating findings from a single center. The results raise the possibility that cardiac monitoring strategies after stroke could eventually be tailored based on a patient's sex, though further studies in larger and more diverse populations would be needed to confirm these findings and understand their clinical implications.
Schmick A, Rohner M, Gebhard C, Luft A, Wegener S. (2026). Sex Differences in Cardiac Rhythm and Conduction Abnormalities After Noncardioembolic Ischemic Stroke.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.126.049854