Unravelling the role of electrocardiogram changes and ejection fraction in ischaemic stroke outcomes

Abstract Background Stroke, a prevailing global cause of mortality, is witnessing a surge in incidences, particularly in lower-income countries. However, existing guidelines fail to adequately address the impact of electrocardiogram (ECG) changes and ejection fraction on the outcomes of ischaemic stroke, as well as the management of stroke-heart syndrome. Main Body Existing literature underscores a strong link between ischaemic stroke and subsequent cardiac manifestations, hinting at their potential as prognostic indicators for adverse stroke outcomes. Post-ischaemic stroke ECG changes correlate with heightened heart disease risks, emphasising the need for post-stroke ECG monitoring. Recommendations include the use of direct oral anticoagulants and warfarin within 14 days of stroke for atrial fibrillation and thrombolytics for other ischaemic strokes. Conflicting findings exist on the prognostic significance of lower left ventricular ejection fraction (LVEF) post-ischaemic stroke, with some studies indicating poorer outcomes. Currently, LVEF does not significantly impact managing ischaemic stroke patients, but anticoagulation may be considered. Stroke-heart syndrome, a rare post-stroke complication, lacks clear understanding and guidelines for physicians. Conclusions ECG changes emerge as potential stroke outcome predictors, with ongoing debate on the utility of lower LVEF. While an ABC approach shows some efficacy for stroke-heart syndrome, additional research is crucial to unravel its ambiguous physiology and clarify these uncertainties.