|
KMID : 1130620190150040545
|
|
Journal of Clinical Neurology
2019 Volume.15 No. 4 p.545 ~ p.554
|
|
|
Long-Term Outcomes of Real-World Korean Patients with Atrial-Fibrillation-Related Stroke and Severely Decreased Ejection Fraction
|
|
Jung Jin-Man
Kim Yong-Hyun
Yu Sung-Wook
O Kyung-Mi
Kim Chi-Kyung
Song Tae-Jin
Kim Yong-Jae
Kim Bum-Joon
Heo Sung-Hyuk
Park Kwang-Yeol
Kim Jeong-Min
Park Jong-Ho
Choi Jay-Chol
Park Man-Seok
Kim Joon-Tae
Choi Kang-Ho
Hwang Yang-Ha
Chung Jong-Won
Bang Oh-Young
Kim Gyeong-Moon
Seo Woo-Keun
|
|
|
Abstract
|
|
|
Background and Purpose: The clinical implications of echocardiography findings for long-term outcomes in atrial fibrillation (AF)-related stroke patients are unknown.
Methods: This was a substudy of the Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts (K-ATTENTION), which is a multicenter-based cohort comprising prospective stroke registries from 11 tertiary centers. Stroke survivors who underwent two-dimensional transthoracic echocardiography during hospitalization were enrolled. Echocardiography markers included the left-ventricle (LV) ejection fraction (LVEF), the left atrium diameter, and the ratio of the peak transmitral filling velocity to the mean mitral annular velocity during early diastole (E/e′ ratio). LVEF was categorized into normal (≥55%), mildly decreased (>40% and <55%), and severely decreased (≤40%). The E/e′ ratio associated with the LV filling pressure was categorized into normal (<8), borderline (≥8 and <15), and elevated (≥15). Kaplan-Meier and Cox regression analyses were performed for recurrent stroke, major adverse cardiac events, and all-cause death.
Results: This study finally included 1,947 patients. Over a median follow-up of 1.65 years (interquartile range, 0.42?2.87 years), the rates of recurrent stroke, major adverse cardiac events, and all-cause death were 35.1, 10.8, and 69.6 cases per 1,000 person-years, respectively. Multivariable analyses demonstrated that severely decreased LVEF was associated with a higher risks of major adverse cardiac events [hazard ratio (HR), 3.91; 95% confidence interval (CI), 1.58?9.69] and all-cause death (HR, 1.95; 95% CI, 1.23?3.10). The multivariable fractional polynomial plot indicated that recurrent stroke might be associated with a lower LVEF.
Conclusions: Severe LV systolic dysfunction could be a determinant of long-term outcomes in AF-related stroke.
|
|
|
KEYWORD
|
|
|
atrial fibrillation, stroke, echocardiography, outcomes
|
|
|
FullTexts / Linksout information
|
|
|
|
|
Listed journal information
|
|
   
|
|