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KMID : 1142120160180020195
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Journal of Stroke
2016 Volume.18 No. 2 p.195 ~ p.202
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Left Ventricular Diastolic Dysfunction in Ischemic Stroke: Functional and Vascular Outcomes
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Park Hong-Kyun
Kim Beom-Joon
Yoon Chang-Hwan
Yang Mi-Hwa
Han Moon-Ku
Bae Hee-Joon
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Abstract
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Background and Purpose: Left ventricular (LV) diastolic dysfunction, developed in relation to myocardial dysfunction and remodeling, is documented in 15%-25% of the population. However, its role in functional recovery and recurrent vascular events after acute ischemic stroke has not been thoroughly investigated.
Methods: In this retrospective observational study, we identified 2,827 ischemic stroke cases with adequate echocardiographic evaluations to assess LV diastolic dysfunction within 1 month after the index stroke. The peak transmitral filling velocity/mean mitral annular velocity during early diastole (E/e’) was used to estimate LV diastolic dysfunction. We divided patients into 3 groups according to E/e’ as follows: <8, 8-15, and ≥15. Recurrent vascular events and functional recovery were prospectively collected at 3 months and 1 year.
Results: Among included patients, E/e’ was 10.6±6.4: E/e’ <8 in 993 (35%), 8-15 in 1,444 (51%), and ≥15 in 378 (13%) cases. Functional dependency or death (modified Rankin Scale score ≥2) and composite vascular events were documented in 1,298 (46%) and 187 (7%) patients, respectively, at 3 months. In multivariable analyses, ischemic stroke cases with E/e’ ≥15 had increased odds of functional dependence or death at 3 months (adjusted OR [95% CI]: 1.73 [1.27-2.35]) or 1 year (1.47 [1.06-2.06]) and vascular events within 1 year (1.65 [1.08-2.51]). Subgroups with normal ejection fraction or sinus rhythm exhibited a similar overall pattern and direction.
Conclusions: LV diastolic dysfunction was associated with poor functional outcomes and composite vascular events up to 1 year.
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KEYWORD
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Left ventricular diastolic dysfunction, Recurrent vascular event, Functional outcome, Acute ischemic stroke
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