Stress Hyperglycemia Ratio Is Associated with Intracardiac Thrombus in Acute Ischemic Stroke

Objective: Transthoracic echocardiography (TTE) is widely used for cardiac evaluation in acute ischemic stroke (AIS), but it may miss intracardiac thrombi that can be detected by transesophageal echocardiography (TEE). The stress hyperglycemia ratio (SHR), which adjusts admission glucose for baseline glycemia, has emerged as a novel biomarker in cardiovascular disease. However, its association with intracardiac thrombus undetected by TTE in AIS remains unclear.
Method: This retrospective study included 486 AIS patients who underwent TEE despite negative baseline TTE findings. Demographic, laboratory, and echocardiographic data were evaluated. Logistic regression and receiver operating characteristic (ROC) analysis were used to assess independent associations with intracardiac thrombus.
Results: TEE detected thrombus in 64 patients (13.2%). Patients with thrombus had higher SHR (0.99 ± 0.42 vs. 0.84 ± 0.27, p < 0.001), glucose, C-reactive protein (CRP), and creatinine levels, and lower ejection fraction. In univariable analysis, SHR showed a strong association with intracardiac thrombus (odds ratio [OR] = 3.68, p < 0.001) and remained independently associated after multivariable adjustment (OR = 2.39, 95% confidence interval: 1.11–5.17, p = 0.027), along with CRP, paroxysmal atrial fibrillation, and male sex, while ejection fraction was inversely associated with thrombus presence. The model demonstrated good discriminative performance (area under the curve: 0.796).
Conclusion: SHR is associated with intracardiac thrombus missed by TTE but detected by TEE in AIS. SHR may enhance risk stratification and help guide selective use of TEE.

Keywords: Acute ischemic stroke, cardioembolism, echocardiography, intracardiac thrombus, risk stratification, stress hyperglycemia ratio