Background It is uncertain whether there is an association between left ventricular (LV) ejection fraction ( LVEF ) or LV wall motion abnormality and embolic stroke of undetermined source ( ESUS ). Methods and Results We performed a retrospective, cross‐sectional study of patients with acute ischemic stroke enrolled in the CAESAR (Cornell Acute Stroke Academic Registry) from 2011 to 2016. We restricted this study to patients with ESUS and, as controls, those with small‐ and large‐artery ischemic strokes. LVEF had to be above 35% to be considered ESUS . In a secondary analysis, we excluded patients with ESUS who had any evidence of ipsilateral carotid atherosclerosis. Multiple logistic regression was used to evaluate whether LVEF or LV wall motion abnormality was associated with ESUS . We performed a confirmatory study at another tertiary‐care center. We identified 885 patients with ESUS (n=503) or small‐ or large‐artery strokes (n=382). Among the entire cohort, LVEF was not associated with ESUS (odds ratio per 5% decrement in LVEF , 1.0; 95% CI, 1.0–1.1) and LV wall motion abnormality was not associated with ESUS (odds ratio, 0.9; 95% CI, 0.5–1.6). The results were identical in our confirmatory study. In our secondary analysis excluding ESUS patients with any evidence of ipsilateral carotid atherosclerosis, there was an association between LVEF and ESUS (odds ratio per 5% decrement in LVEF , 1.2; 95% CI, 1.0–1.5; P =0.04). Conclusions Among the entire cohort, no association existed between LVEF or LV wall motion abnormality and ESUS ; however, after excluding ESUS patients with any evidence of ipsilateral carotid atherosclerosis, lower LVEF appeared to be associated with ESUS .
Besides, we collected information related to their household level socioeconomic , demographic and lifestyle information through individual interviews with household members. Findings: We found the chance of having pre-hypertension increases with the increase with age irrespective of gender. Women are more suffer than men for developing pre-HTN (2.31 vs 1.46) and HTN (4.25 times respectively). However, obese men had a high chance 2.46 and 4.23 times higher of developing of pre-HTN and HTN than that of women (1.48 and 2.58 times). Those men and women who sleep more than >9 hours in 24 hrs were more likely to be pre-hypertensive (men 1.32 and female 1.53 times) and hypertensive (men 1.30 and female 1.38 times). The chance of being hypertensive reduced when men and women sleep 6 hours (1.04 and 1.17 times respectively). Interestingly, although small but still at risk of developing HTN were men who snored. It was found that 20% of men and 19 % of women who snored had hypertension. Interpretation: This study add with the existing knowledge of lifestyle modifiable factors for pre-hypertension and hypertension that snoring is an independent factors for developing pre-hypertension and hypertension.
Introduction: Severely reduced left ventricular (LV) ejection fraction (EF) is an established risk factor for ischemic stroke. It is uncertain whether a modest reduction in LVEF (between 35%-50%) or the presence of LV wall motion abnormality may be a potential explanation for some embolic strokes of undetermined source (ESUS). Methods: We performed a retrospective cross-sectional study of patients with acute ischemic stroke enrolled in the Cornell AcutE Stroke Academic Registry (CAESAR) from 2011 through 2016. For this analysis, we restricted the study cohort to patients with ESUS and, as controls, those with small- and large-artery ischemic strokes who received an echocardiogram within 14 days of stroke. A single investigator blinded to stroke subtype recorded LVEF and the presence of LV wall motion abnormalities from reports of echocardiograms performed for routine evaluation of stroke. These variables are uniformly reported in echocardiogram reports at our institution. Multiple logistic regression models adjusted for demographics and stroke risk factors were used to evaluate whether LVEF or LV wall motion abnormality was associated with ESUS. Results: We identified 885 patients with ESUS or small- or large-artery strokes. The mean LVEF was 62.4% (+/- 7.9%). There was no difference in LVEF in patients with ESUS (62.4%; 95% CI, 61.8-63.1%) as compared to patients with small- or large-artery strokes (62.3%; 95% CI, 61.4-63.2%; P =0.8). After adjustment for demographics and stroke risk factors, LVEF was not associated with ESUS (OR per 10% incremental increase in LVEF, 0.9; 95% CI, 0.8-1.0; P = 0.4). LV wall motion abnormality was present in 5.9% of patients, and in multivariable analysis, its presence was not associated with ESUS (OR 0.9; 95% CI, 0.5-1.6; P = 0.7). Conclusions: We found that neither a modest reduction in LVEF nor the presence of LV wall motion abnormality was associated with ESUS.
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