Left Ventricular Diastolic Dysfunction in Ischemic Stroke: Functional and Vascular Outcomes.
OBJECTIVE
Left ventricular (LV) diastolic dysfunction, developed in relation to myocardial dysfunction and remodeling, is documented in 15%-25% of the population. However, its role in functional recovery and recurrent vascular events after acute ischemic stroke has not been thoroughly investigated.


METHODS
In this retrospective observational study, we identified 2,827 ischemic stroke cases with adequate echocardiographic evaluations to assess LV diastolic dysfunction within 1 month after the index stroke. The peak transmitral filling velocity/mean mitral annular velocity during early diastole (E/e') was used to estimate LV diastolic dysfunction. We divided patients into 3 groups according to E/e' as follows: <8, 8-15, and ≥15. Recurrent vascular events and functional recovery were prospectively collected at 3 months and 1 year.


RESULTS
Among included patients, E/e' was 10.6±6.4: E/e' <8 in 993 (35%), 8-15 in 1,444 (51%), and ≥15 in 378 (13%) cases. Functional dependency or death (modified Rankin Scale score ≥2) and composite vascular events were documented in 1,298 (46%) and 187 (7%) patients, respectively, at 3 months. In multivariable analyses, ischemic stroke cases with E/e' ≥15 had increased odds of functional dependence or death at 3 months (adjusted OR [95% CI]: 1.73 [1.27-2.35]) or 1 year (1.47 [1.06-2.06]) and vascular events within 1 year (1.65 [1.08-2.51]). Subgroups with normal ejection fraction or sinus rhythm exhibited a similar overall pattern and direction.


CONCLUSIONS
LV diastolic dysfunction was associated with poor functional outcomes and composite vascular events up to 1 year.
Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
Hong-Kyun
HK
Park
Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
Beom Joon
BJ
Kim
Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Chang-Hwan
CH
Yoon
Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
Mi Hwa
MH
Yang
Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
Moon-Ku
MK
Han
Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
Hee-Joon
HJ
Bae
Acute ischemic stroke; Functional outcome; Left ventricular diastolic dysfunction; Recurrent vascular event