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Diastolic Dysfunction as a Positive Predictor of Recurrent Vascular Events in Patients With Noncardioembolic Stroke
Kentaro Ishizuka1, Takao Hoshino1, Takafumi Mizuno1
1Department of Neurology, Tokyo Women's Medical University School of Medicine, Japan.
Insights
Left ventricular diastolic dysfunction (LVDD) increases the risk of major adverse cardiovascular events after noncardioembolic stroke. Evaluating LVDD is crucial for risk stratification and secondary prevention strategies in these patients.
Area of Science:
- Cardiology
- Neurology
- Vascular Medicine
Background:
- Left ventricular diastolic dysfunction (LVDD) is a condition affecting heart relaxation.
- Its impact on vascular outcomes following noncardioembolic stroke requires further investigation.
Purpose of the Study:
- To assess the association between left ventricular diastolic dysfunction (LVDD) and vascular outcomes in patients with noncardioembolic stroke.
- To determine if LVDD is an independent predictor of major adverse cardiovascular events post-stroke.
Main Methods:
- A prospective observational study of 563 patients with noncardioembolic stroke.
- Patients were categorized into LVDD and non-LVDD groups.
- Major adverse cardiovascular events (MACE) were tracked for 1 year using multivariable Cox regression.
Main Results:
- 23.1% of patients had LVDD, showing a significantly higher 1-year MACE rate (20.9% vs. 10.8%).
- LVDD was independently associated with increased MACE risk (HR, 1.79; P=0.019).
- Higher LVDD grade correlated with increased MACE and recurrent stroke risk.
Conclusions:
- LVDD is linked to heightened vascular event risk after noncardioembolic stroke.
- LVDD assessment is vital for risk stratification and secondary prevention in this patient population.
Background:
This study aimed to assess the effects of left ventricular diastolic dysfunction (LVDD) on vascular outcomes among patients with stroke of noncardioembolic origins.
Methods:
This prospective observational study enrolled 563 patients with noncardioembolic stroke (mean age, 67.9 years; 66.7% men and 33.3% women individuals) registered in the Tokyo Women's Medical University Stroke Registry between 2013 and 2020. Then, patients were divided into the LVDD and non-LVDD groups. The primary outcome was a composite of major adverse cardiovascular events, including nonfatal stroke, nonfatal acute coronary syndrome, and vascular death 1 year after stroke onset. The effect of LVDD on vascular events was assessed using multivariable Cox regression analyses.
Results:
A total of 130 (23.1%) patients had any grade of LVDD, and patients with LVDD had a higher risk of major adverse cardiovascular event at 1 year than those without LVDD (annual rate, 20.9% versus 10.8%; log-rank P=0.001). The multivariable Cox proportional hazards regression model demonstrated that the presence of LVDD was independently associated with the major adverse cardiovascular event risk (hazard ratio, 1.79 [95% CI, 1.02-3.12]; P=0.019). Furthermore, the LVDD grade was proportional to the risk of major adverse cardiovascular events and recurrent stroke.
Conclusions:
LVDD may be associated with further vascular events after a noncardioembolic stroke, suggesting the importance of LVDD evaluations in risk stratification and secondary prevention in patients with noncardioembolic stroke.
Registration:
URL: https://upload.umin.ac.jp; Unique identifier: UMIN000031913.
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