Cardiac function and outcome in patients with cardio-embolic stroke

Area of Science:

• Cardiology
• Neurology
• Medical Imaging

Background:

• The prognostic value of the full spectrum of ejection fraction (EF) in cardioembolic stroke (CES) remains incompletely understood.
• The impact of borderline EF (41-49%) on CES outcomes requires further clarification.

Purpose of the Study:

• To investigate the association between varying ejection fraction (EF) levels and outcomes in patients experiencing cardioembolic stroke (CES).
• To determine if lower and borderline EF predict adverse outcomes in CES patients.

Main Methods:

• A cohort of 437 CES patients was analyzed, assessing EF as both a continuous and categorical variable (≤40%, 41-49%, ≥50%).
• Outcomes evaluated included poor short-term functional status (modified Rankin Score ≥3 at discharge or death within 90 days) and long-term mortality.
• Multivariable models adjusted for covariates were used to assess the relationship between EF and mortality.

Main Results:

• A total of 37.8% of patients experienced poor short-term outcomes. Lower EF was associated with poorer outcomes.
• In multivariable analysis, a 1% increase in EF significantly reduced mortality risk by 3% in CES patients and 2% in the atrial fibrillation (AF) subgroup.
• Reduced EF (≤40%) was linked to significantly higher mortality (HR 2.61), and borderline EF (41-49%) showed a trend towards higher mortality (HR 1.65, p=0.067) compared to normal EF.

Conclusions:

• A significant association exists between reduced ejection fraction (EF) and adverse outcomes in patients with cardioembolic stroke (CES).
• Echocardiographic assessment of EF is valuable for predicting prognosis in CES patients, including those with atrial fibrillation (AF).