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Left Ventricular Diastolic Dysfunction as Predictor of Unfavorable Prognosis After ESUS

Agata Bielecka-Dabrowa1,2, Paulina Gasiorek2, Andrzej Wittczak2

  • 1Heart Failure Unit, Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland.

Journal of Multidisciplinary Healthcare
|March 17, 2021
PubMed

Insights

Diastolic dysfunction predicts poor outcomes in embolic strokes of undetermined origin (ESUS) patients under 65. Early diastolic mitral annular velocity (E/E') is a key predictor of recurrent stroke and composite endpoints.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Diagnostics

Background:

  • Embolic strokes of undetermined etiology (ESUS) represent a significant proportion of ischemic strokes.
  • Predicting prognosis in younger ESUS patients (<65 years) requires identification of specific risk factors.
  • Echocardiographic and hemodynamic parameters may offer insights into stroke risk.

Purpose of the Study:

  • To identify echocardiographic, hemodynamic, and biochemical predictors of unfavorable prognosis in patients under 65 with ESUS.
  • To assess the association of these predictors with cardiovascular hospitalizations, recurrent stroke, and composite endpoints.

Main Methods:

  • A cohort of 64 ESUS patients and 36 controls underwent echocardiography and non-invasive hemodynamic assessment.
  • Biomarkers were measured, and patients were followed for 12 months.
  • Multivariate analysis was used to identify independent predictors of adverse outcomes.

Main Results:

  • The ratio of early diastolic transmitral flow to early diastolic mitral annular motion (E/E") was an independent predictor of recurrent stroke (OR 0.75, p=0.01).
  • E/E" was also associated with a composite endpoint of death, hospitalization, and recurrent stroke (OR 1.90, p=0.01).
  • Mean early diastolic mitral annular velocity (E') was linked to cardiovascular hospitalizations (OR 0.75, p=0.01).

Conclusions:

  • Indices of diastolic dysfunction, particularly E/E", are significantly associated with unfavorable prognosis in younger ESUS patients.
  • Outpatient cardiac monitoring, especially in the first two months post-hospitalization, is crucial for detecting atrial fibrillation (AF).
  • These findings highlight the importance of diastolic function assessment in managing ESUS.
Abstract

Keywords:
atrial fibrillationdiastolic dysfunctiondiastolic heart failureischemic stroke of undetermined etiology

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