Abstract / Summary
Cardiovascular issues often arise after acute ischemic stroke, affecting both morbidity and mortality. Although cardiac performance is often reduced after stroke, the relationship between stroke severity, cardiac metrics, and prognostic value remains unclear. This systematic review examined the evidence linking stroke severity with cardiac dysfunction, assessed using conventional and advanced echocardiographic parameters, and their prognostic significance. This systematic review followed PRISMA guidelines and used four databases: PubMed, Scopus, Web of Science, and Google Scholar. It focused on 2015 to 2025 studies examining echocardiographic parameters, stroke severity, and outcomes after stroke. Because of heterogeneity in classifications, methods, severity measures, and outcome parameters, no meta-analysis was performed. The synthesized evidence strongly demonstrates that echocardiographic parameters correlate with stroke severity—measured by the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores—and predict poor outcomes in both ischemic and hemorrhagic stroke. Reduced left ventricular ejection fraction (LVEF; particularly \(\:<48\%\) or \(\:<60\%\) ) independently predicts acute deterioration, short-term functional disability ( \(\:\text{mRS}\text{}3\text{\--}6\) at 90 days), and adverse clinical events. Global longitudinal strain (GLS) serves as a sensitive, independent marker across the stroke continuum, detecting subclinical myocardial dysfunction despite normal LVEF and improving risk stratification. Additionally, novel myocardial work efficiency (MWE) indices show the strongest correlations with initial NIHSS scores, offering promise for detecting early myocardial impairment. E value and NIHSS serve as complementary independent predictors rather than direct correlates—each contributes unique prognostic information for identifying AIS patients at risk for unfavorable outcomes at discharge and during the 3-month follow-up period. Left atrial parameters—specifically Left Atrium Diameter (LAD) and Left Atrial Volume Index (LAVI)—correlate with admission NIHSS and independently predict adverse outcomes. Among diagnostic modalities, 3D speckle-tracking echocardiography (STE), particularly reservoir strain ( \(\:{\text{LAS}}_{r-c}\) ) offers superior utility in identifying cardioembolic stroke. Ultimately, integrating information from key echocardiographic markers (LVEF, GLS, LAVI, MWE) along with NIHSS scores could enhance stroke risk stratification and prognosis prediction post-stroke. Given the evidence linking echocardiographic parameters to neurological severity, risk, and predictive precision, cardiac monitoring-sensitive parameters should be integrated into post-stroke care. Future studies should define these relevant thresholds. Predictive models that incorporate stroke severity and echocardiographic parameters require testing for accuracy and validation in larger populations before their application in clinical decision-making.