Left Ventricular Diastolic Dysfunction in Ischemic Stroke: Functional and Vascular Outcomes
Hong-Kyun Park1, Beom Joon Kim1, Chang-Hwan Yoon2
1Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
Insights
Left ventricular diastolic dysfunction, indicated by elevated E/e' ratios, is linked to worse outcomes after ischemic stroke. This includes increased risk of functional dependence, death, and recurrent vascular events within one year.
Area of Science:
- Cardiology
- Neurology
- Echocardiography
Background:
- Left ventricular (LV) diastolic dysfunction affects 15%-25% of the population.
- Its impact on functional recovery and recurrent vascular events post-ischemic stroke is understudied.
Purpose of the Study:
- To investigate the association between LV diastolic dysfunction and outcomes after acute ischemic stroke.
- To evaluate the role of E/e' ratio in predicting functional recovery and vascular events.
Main Methods:
- Retrospective observational study of 2,827 ischemic stroke patients.
- Echocardiographic assessment of LV diastolic dysfunction using E/e' ratio within 1 month post-stroke.
- Prospective collection of functional recovery and vascular event data at 3 months and 1 year.
Main Results:
- Elevated E/e' (≥15) was observed in 13% of patients.
- Patients with E/e' ≥15 showed increased odds of functional dependence or death at 3 months (aOR 1.73) and 1 year (aOR 1.47).
- Higher E/e' was also associated with increased odds of 1-year vascular events (aOR 1.65).
Conclusions:
- Left ventricular diastolic dysfunction is significantly associated with adverse functional outcomes.
- LV diastolic dysfunction predicts an increased risk of composite vascular events up to 1 year post-stroke.
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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