title: Diastolic myocardial dysfunction by tissue Doppler imaging predicts mortality in patients with cerebral infarction.
abstract: Several clinical prediction score models have been investigated for predicting mortality in patients with cerebral infarction. However, none of these include echocardiographic measures. Our objective was to evaluate the prognostic value of tissue Doppler imaging (TDI) of the myocardium in patients with cerebral infarction. Two hundred forty-four patients with cerebral infarction and subsequent echocardiographic examination in sinus rhythm were identified. Using TDI in three apical projections, longitudinal mitral annular velocities were obtained in six segments. Cox regression models, C-statistics and reclassification analysis were performed for global and segmental e'. During a median follow-up of 3 years 42 patients died. Patients who died had significantly impaired systolic and diastolic function (determined by LVEF and E/e'). The risk of dying increased with decreasing global e', being approximately 13 times higher for patients in the lowest tertile compared to patients in the highest tertile (HR 13.4 [3.2;56.3], p < 0.001). Patients with significantly impaired global e' showed increased mortality after multivariable adjustment for: LVEF, E/e', age, gender, heart failure, chronic obstructive pulmonary disease, prior cerebral infarction, ischemic heart disease, cancer, hypertension, hypercholesterolemia, carotid stenosis, mitral regurgitation, liver disease and thromboembolisms (HR 1.9 [1.1;3.2]), per 1 cm/s decrease, p < 0.05). Similar pattern was seen in segmental analyses of the e'. In contrast to e', no conventional echocardiographic parameters remained independent predictors of mortality after multivariable adjustment. Diastolic myocardial dysfunction determined as e' by TDI is a significant predictor of mortality in patients with cerebral infarction. Applying this parameter can aid the prognostic assessment after cerebral infarction.
authors.affiliation: Department of Cardiology, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, P.835, 2900, Hellerup, Denmark. flemming.j.olsen@gmail.com.
authors.forename: Flemming J
authors.initials: FJ
authors.lastname: Olsen
authors.affiliation: Department of Cardiology, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, P.835, 2900, Hellerup, Denmark.|Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Jørgensen
authors.affiliation: Department of Cardiology, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, P.835, 2900, Hellerup, Denmark.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Møgelvang
authors.affiliation: Department of Cardiology, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, P.835, 2900, Hellerup, Denmark.|Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jan S
authors.initials: JS
authors.lastname: Jensen
authors.affiliation: Department of Cardiology, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, P.835, 2900, Hellerup, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fritz-Hansen
authors.affiliation: Department of Cardiology, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, P.835, 2900, Hellerup, Denmark.
authors.forename: Jan
authors.initials: J
authors.lastname: Bech
authors.affiliation: Department of Cardiology, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, P.835, 2900, Hellerup, Denmark.
authors.forename: Jacob
authors.initials: J
authors.lastname: Sivertsen
authors.affiliation: Department of Cardiology, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, P.835, 2900, Hellerup, Denmark.|Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Tor
authors.initials: T
authors.lastname: Biering-Sørensen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002544:Cerebral Infarction / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D016009:Chi-Square Distribution; D003971:Diastole; D018618:Echocardiography, Doppler, Color; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D016277:Ventricular Function, Left
keywords: Echocardiography; Ischemic stroke; Prognosis; Tissue Doppler imaging