Reader Response: First-Ever Ischemic Stroke and Increased Risk of Incident Heart Disease in Older Adults

In their large population-based study, Sposato et al.1 reported that ischemic stroke was independently associated with a higher risk of a subsequent major adverse cardiovascular event, such as myocardial infarction, congestive heart failure, coronary artery disease, or cardiovascular death. As the authors concluded, it was unclear whether these events were stroke-related or because of preexisting subclincal cardiovascular conditions. Interestingly, using myocardial perfusion imaging (MPI) with 99mTechnetium-tetrofosmin-single-photon emission computed tomography (SPECT), we have recently reported that 62% of 52 patients exhibited myocardial ischemia within a month after an ischemic stroke.2 These patients had no known history or symptoms of coronary artery disease or any other heart disease. Although the etiology of the cardiac abnormalities in the stroke patients remains unclear, it is wise to assess them after the stroke using the noninvasive method of MPI SPECT. MPI SPECT represents a sensitive and accurate method to detect even minimal myocardial dysfunction and proceed with coronary angiography only if the MPI demonstrates abnormalities.2,3

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