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Diastolic Dysfunction and the Risk of Stroke and Major Bleeding
John Kundrick1, Karina I Saba1, Aditi Naniwadekar1
1Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA.
Insights
Left ventricular diastolic dysfunction (DD) independently increases the risk of stroke, transient ischemic attack (TIA), and major bleeding events. This finding highlights the importance of considering DD in patient risk assessment and management strategies.
Area of Science:
- Cardiology
- Vascular Medicine
- Clinical Epidemiology
Background:
- Left ventricular diastolic dysfunction (DD) is a known risk factor for adverse cardiovascular outcomes, including atrial fibrillation.
- The independent association between DD and the risk of incident stroke, transient ischemic attack (TIA), and major bleeding events has not been established.
- This study aimed to investigate the impact of DD on the incidence of stroke/TIA and major bleeding.
Purpose of the Study:
- To determine if left ventricular diastolic dysfunction (DD) is an independent predictor of incident stroke/TIA.
- To assess the association between DD and the risk of major bleeding events.
- To evaluate the impact of DD severity on these adverse outcomes.
Main Methods:
- An observational cohort analysis was conducted, including patients with at least one cardiac echocardiogram and a follow-up of at least 3 months.
- Patients were categorized into four groups based on the severity of DD assessed from echocardiographic reports.
- Exclusion criteria included prior history of stroke, TIA, or major bleeding. Multivariable Cox proportional hazards models were used to evaluate predictors of stroke/TIA and major bleeding.
Main Results:
- The study cohort comprised 96,702 patients with no DD and 18,164, 5,881, and 1,340 patients with DD grades I, II, and III, respectively.
- Over a median follow-up of 3.4 years, incident stroke/TIA occurred in 2.4% of patients and major bleeding in 4.6%.
- After multivariable adjustment, DD was a significant predictor of both incident stroke/TIA (HR, 1.22 per grade increase; P<0.001) and major bleeding (HR, 1.20 per grade increase; P<0.001).
Conclusions:
- Left ventricular diastolic dysfunction (DD) is independently associated with an increased risk of cerebrovascular accidents (stroke/TIA) and major bleeding.
- The severity of DD correlates with the magnitude of risk for these adverse events.
- DD should be considered a crucial factor in patient risk stratification and in guiding management decisions for cardiovascular health.
Background:
Left ventricular diastolic dysfunction (DD) is associated with adverse cardiovascular outcomes including atrial fibrillation. Whether DD is independently associated with incident stroke and transient ischemic attack (TIA) and with bleeding events is not known. We performed this observational cohort analysis to examine the impact of DD on the risk of stroke/TIA and major bleeding.
Methods:
Patients who underwent at least 1 cardiac echocardiogram and were followed for at least 3 months were included in this study. Patients with a prior history of stroke, TIA, or major bleeding, as determined by International Classifications of Diseases codes, were excluded. Smart key-phrase search was applied to echocardiographic reports to classify patients into 4 groups based on the most severe DD assessment. Patients in whom the presence of DD could not be determined were excluded. The final study cohort was followed to the end point of hospital admission for stroke/TIA and major bleeding, and independent predictors of these events were evaluated using the multivariable Cox proportional hazards method.
Results:
The final study cohort (age, 56±18 years; 56% women) had 96 702 patients with no DD and 18 164, 5881, and 1340 patients with DD grades I, II, and III, respectively. Over a median follow-up of 3.4 years, 2938 (2.4%) patients were hospitalized for stroke/TIA and 5567 (4.6%) for major bleeding. After adjusting for age, the CHA2DS2-VASc score, chronic kidney disease, use of antiplatelet agents, use of anticoagulation agents, the year of echocardiographic testing, household income, and history of atrial fibrillation, DD remained a strong predictor of incident stroke/TIA (hazard ratio, 1.22 per grade increase in DD [95% CI, 1.16-1.29]; P<0.001) and major bleeding (hazard ratio, 1.20 per grade increase in DD [95% CI, 1.16-1.25]; P<0.001).
Conclusions:
DD is independently associated with a higher risk of cerebrovascular accidents and major bleeding. DD should be considered when counseling patients regarding their risk profile and management options.
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