ABSTRACT NUMBER: ESOC2026A1483 ECHOCARDIOGRAPHIC STRAIN UNMASKS OSA-ASSOCIATED CARDIAC INJURY IN ACUTE STROKE: A DIRECT COMPARISON WITH STOP-BANG

Abstract Background and aims Obstructive sleep apnea (OSA) is highly prevalent in acute ischemic stroke (AIS), associated with adverse outcomes, yet often underdiagnosed. This study assessed right ventricular (RV) longitudinal strain—a sensitive indicator of subclinical cardiac dysfunction—and compared its diagnostic performance to the STOP-BANG questionnaire for OSA screening in AIS. Methods Eighty-nine AIS patients underwent respiratory polygraphy and echocardiography with RV strain analysis. RV function was assessed using conventional indices (TAPSE, FAC, tricuspid S′) and speckle-tracking derived RV global longitudinal strain (RV-GLS) and free-wall strain (RV-FWLS). ROC curves evaluated diagnostic performance. Results OSA was diagnosed in 56/89 patients (62.9%). Conventional RV indices did not differ between groups, while RV-GLS and RV-FWLS were significantly reduced in OSA patients (–19.3±3.0% vs. –21.2±2.7%, p=0.004; –23.5±4.3% vs. –25.8±3.2%, p=0.009). AHI independently predicted strain impairment. Overall, RV-GLS demonstrated superior discriminative ability for identifying OSA compared to the STOP-BANG score (AUC 0.701 vs. 0.642). In the cryptogenic stroke subgroup (n=30), diagnostic performance was further improved (AUC 0.860 for RV-GLS, 0.839 for RV-FWLS). An optimal RV-GLS cut-off of –20.25% yielded 82.4% sensitivity and 76.9% specificity for detecting OSA in this subgroup. Conclusions RV longitudinal strain detects subclinical systolic dysfunction in AIS patients with OSA, even when conventional parameters are preserved. These findings support the hypothesis that chronic RV remodeling results from pre-existing OSA, rather than from acute stroke-related neurogenic changes. Incorporating RV strain into routine echocardiography—particularly in cryptogenic stroke—may enable early detection of occult OSA and guide timely intervention for improved outcomes. Conflict of interest Tho Phung: nothing to disclose Hoai-Thi-Thu Nguyen: nothing to disclose Giap Vu: nothing to disclose