Diastolic Dysfunction and Outcome in Acute Ischemic Stroke
Wi-Sun Ryu1, Jun-Bean Park, Sang-Bae Ko
1Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea.
Insights
Left ventricular diastolic dysfunction (DD) is linked to worse outcomes and higher mortality in ischemic stroke patients. Early detection and management of DD are crucial for improving patient prognosis after stroke.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Left ventricular diastolic dysfunction (DD) is a known predictor of mortality in the general population and post-myocardial infarct patients.
- The prognostic value of DD in acute ischemic stroke patients with preserved ejection fraction remains less understood.
Purpose of the Study:
- To investigate the association between left ventricular diastolic dysfunction (DD) and clinical outcomes, including functional status and mortality, in patients following acute ischemic stroke.
Main Methods:
- Retrospective analysis of 503 acute ischemic stroke patients with normal left ventricular ejection fraction (≥50%).
- Diastolic function was assessed using echocardiography and tissue Doppler imaging.
- Ordinal logistic and Cox regression analyses were employed to evaluate the relationship between DD and modified Rankin Scale (mRS) scores at 3 months and mortality.
Main Results:
- The ratio of early mitral inflow velocity to early diastolic mitral annulus velocity (E/e') emerged as an independent predictor of poorer functional outcomes and increased mortality.
- Patients in the highest quartile of E/e' (>14) showed significantly higher odds of adverse functional outcomes (adjusted OR 3.86) and mortality (HR 2.87) compared to the lowest quartile (<8.8).
- Moderate-to-severe DD grades were independently associated with significantly worse mRS scores (adjusted OR 2.41) and higher mortality (HR 6.63) compared to normal diastolic function.
Conclusions:
- Left ventricular diastolic dysfunction (DD) is significantly associated with adverse functional outcomes and increased mortality in patients recovering from ischemic stroke.
- These findings underscore the importance of evaluating diastolic function in ischemic stroke patients to better stratify risk and guide management strategies.
Background:
Left ventricular diastolic dysfunction (DD) is associated with an increased mortality in general population and patients with myocardial infarct. In the present study, we investigated whether DD is associated with outcomes after ischemic stroke.
Methods:
Five hundred and three acute ischemic stroke patients with normal left ventricular ejection fraction (≥50%) were retrospectively included. Echocardiography and tissue Doppler imaging were used to evaluate and grade diastolic function. Ordinal logistic and Cox regression analyses were used to examine relations between DD and modified Rankin Scale (mRS) score at 3 months and mortality after stroke, respectively.
Results:
Mean age was 67.2 ± 11.8 years and 63% were men. Among parameters of diastolic function, early mitral inflow velocity/early diastolic mitral annulus velocity (E/e') was independently related with higher mRS score at 3 months and mortality after ischemic stroke. The highest quartile of E/e' (>14) was independently associated with higher mRS score (adjusted OR 3.86, 95% CI 2.27-6.54) as well as with mortality (hazards ratio [HR] 2.87, 95% CI 1.17-7.04) as compared to the lowest quartile of E/e' (<8.8). In addition, moderate-to-severe DD grade was related to higher mRS score (adjusted OR 2.41, 95% CI 1.15-5.06) and mortality (HR 6.63, 95% CI 1.80-24.43) compared to the normal diastolic function.
Conclusion:
In patients with ischemic stroke, DD is associated with functional outcome at 3 months and mortality. Our data suggest that more attention should be given to DD in patients with ischemic stroke.
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