title: Implication of left ventricular diastolic dysfunction in cryptogenic ischemic stroke.
abstract: OBJECTIVE
  Left ventricular diastolic dysfunction (LVDD) is a predictor for atrial fibrillation (AF). This study was aimed to investigate whether LVDD in cryptogenic ischemic stroke (CS) could be a clue to stroke mechanism.
  
  
  METHODS
  The clinical and echocardiographic findings of 1589 consecutive patients with acute ischemic stroke or transient ischemic attack between 2004 and 2013 were reviewed. LVDDs among stroke subtypes were graded by transthoracic echocardiography into 4 groups by severity: normal, abnormal relaxation (grade I), pseudonormal (grade II), and restrictive diastolic filling (grade III), whereas severe LVDD was defined as grade III. We classified the lesion pattern of CS into cardioembolism-mimic or non-cardioembolism-mimic and determined whether cardioembolism-mimic lesions were associated with severe LVDD.
  
  
  RESULTS
  The fraction of severe LVDD in CS was not different from that of stroke with AF (27.3% versus 37.1%; P=0.173) but was significantly higher than that of stroke without AF (27.3% versus 13.4%; P=0.008). Cardioembolism-mimic CS had more severe LVDD than non-cardioembolism-mimic CS (41.4% versus 11.5%; P=0.013). LVDD of grade II (odds ratio, 4.37; 95% confidence interval, 2.99-6.41) and grade III (odds ratio, 5.60; 95% confidence interval, 3.42-9.17) were independently related to stroke with AF after adjusting covariates.
  
  
  CONCLUSIONS
  The severe LVDD could be a predictor of stroke with AF, and its frequency was similar between CS and stroke with AF. Cardioembolism-mimic CS had significantly more severe LVDD than non-cardioembolism-mimic CS. LVDD could be helpful to discriminate the stroke mechanism in the patients with acute CS.
authors: From the Departments of Neurology (J.-Y.S., K.B.L., J.-G.L., J.-S.K., H.R., M.-Y.A.) and Cardiology (B.W.P., M.S.H.), Soonchunhyang University School of Medicine, Seoul, Korea.
authors: Jae-Young
authors: JY
authors: Seo
authors: From the Departments of Neurology (J.-Y.S., K.B.L., J.-G.L., J.-S.K., H.R., M.-Y.A.) and Cardiology (B.W.P., M.S.H.), Soonchunhyang University School of Medicine, Seoul, Korea. kblee@schmc.ac.kr.
authors: Kyung Bok
authors: KB
authors: Lee
authors: From the Departments of Neurology (J.-Y.S., K.B.L., J.-G.L., J.-S.K., H.R., M.-Y.A.) and Cardiology (B.W.P., M.S.H.), Soonchunhyang University School of Medicine, Seoul, Korea.
authors: Jung-Gon
authors: JG
authors: Lee
authors: From the Departments of Neurology (J.-Y.S., K.B.L., J.-G.L., J.-S.K., H.R., M.-Y.A.) and Cardiology (B.W.P., M.S.H.), Soonchunhyang University School of Medicine, Seoul, Korea.
authors: Ji-Sun
authors: JS
authors: Kim
authors: From the Departments of Neurology (J.-Y.S., K.B.L., J.-G.L., J.-S.K., H.R., M.-Y.A.) and Cardiology (B.W.P., M.S.H.), Soonchunhyang University School of Medicine, Seoul, Korea.
authors: Hakjae
authors: H
authors: Roh
authors: From the Departments of Neurology (J.-Y.S., K.B.L., J.-G.L., J.-S.K., H.R., M.-Y.A.) and Cardiology (B.W.P., M.S.H.), Soonchunhyang University School of Medicine, Seoul, Korea.
authors: Moo-Young
authors: MY
authors: Ahn
authors: From the Departments of Neurology (J.-Y.S., K.B.L., J.-G.L., J.-S.K., H.R., M.-Y.A.) and Cardiology (B.W.P., M.S.H.), Soonchunhyang University School of Medicine, Seoul, Korea.
authors: Byoung Won
authors: BW
authors: Park
authors: From the Departments of Neurology (J.-Y.S., K.B.L., J.-G.L., J.-S.K., H.R., M.-Y.A.) and Cardiology (B.W.P., M.S.H.), Soonchunhyang University School of Medicine, Seoul, Korea.
authors: Min Su
authors: MS
authors: Hyon
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology; D001921:Brain / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging; D004452:Echocardiography; D005260:Female; D006801:Humans; D007511:Ischemia / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000503:physiopathology; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging
keywords: atrial fibrillation; echocardiography; stroke