Implication of Left Ventricular Diastolic Dysfunction in Cryptogenic Ischemic Stroke

Seo, Jae-Young; Lee, Kyung Bok; Lee, Jung-Gon; Kim, Ji Sun; Roh, Hee-Tae; Ahn, Moo-Young; Park, Byoung Won; Hyon, Min Su

doi:10.1161/strokeaha.114.006108

Cited by 31 publications

(21 citation statements)

References 39 publications

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“…LAV min has been associated with increased adverse events including ischaemic stroke [24]. LAV min is also a marker of LV diastolic dysfunction [25]; LV diastolic dysfunction is more prevalent in CE and undetermined aetiology stroke, compared to non-CE stroke [26]. E/E 0 , a surrogate marker of LV end-diastolic pressure, was increased in the CE and undetermined aetiology groups compared to healthy controls (Table 3).…”

Section: Discussionmentioning

confidence: 99%

Clinical and echocardiographic characteristics of cardioembolic stroke

Ferkh

Brown

O'Keefe

et al. 2019

Euro J of Neurology

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Background and purpose Ischaemic stroke frequently has a cardioembolic (CE) source. Clinical and echocardiographic parameters associated with CE stroke were evaluated. Methods In all, 93 consecutive ischaemic stroke patients who underwent a transthoracic echocardiogram were retrospectively analysed; strokes were classified by TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria. Echocardiographic parameters related to CE stroke, including left atrial volumes and function, were compared to 73 healthy controls. Results Of 93 patients (mean age 66.1 years, 56% male), nine (10%) had large artery atherosclerosis, 38 (41%) CE stroke, two (2%) small vessel disease, two (2%) other and 42 (45%) undetermined aetiology. Left atrial (LA) maximum volumes (LAVImax) and minimum volumes (LAVImin) were larger in the CE group than the non‐CE group (45 vs. 32 ml/m2, 32 vs. 13 ml/m2, respectively, P < 0.001), whilst LA function indices including LA emptying fraction and LA function index (LAFI) were lower in the CE group (34% vs. 55%, and 0.12 vs. 0.35, respectively, P < 0.001). Adjusting for clinical characteristics, LAFI ≤0.3 was an independent predictor of CE stroke (adjusted odds ratio 5.3, P = 0.001). Additionally, LAVImax and LAVImin were larger (61 vs. 44 and 32 vs. 24 ml/m2 respectively, P < 0.01) and LAFI significantly lower (0.34 vs. 0.52, P < 0.001) in the undetermined aetiology group versus healthy controls. Conclusions Left atrial enlargement with reduced LA function was associated with CE stroke and LAFI was the best independent predictor. LA parameters were also altered in the undetermined aetiology group, suggesting an underlying LA myopathy in this subset.

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Section: Discussionmentioning

confidence: 99%

Clinical and echocardiographic characteristics of cardioembolic stroke

Ferkh

Brown

O'Keefe

et al. 2019

Euro J of Neurology

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“…Additionally, the individual risk for recurrent stroke or vascular events may be altered by the presence of asymptomatic LV diastolic dysfunction. However, its clinical implication has only been studied in relation to a potential source of cryptogenic stroke [ 9 ], although LV diastolic dysfunction could be evaluated by a routine cardiac echocardiography, which is widely available [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Left Ventricular Diastolic Dysfunction in Ischemic Stroke: Functional and Vascular Outcomes

et al. 2016

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Background and PurposeLeft 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.MethodsIn 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.ResultsAmong 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.ConclusionsLV diastolic dysfunction was associated with poor functional outcomes and composite vascular events up to 1 year.

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“…They can result from coexisting with LVDD undetected AF. LVDD is a recognised risk factor for AF, and it can be associated with the progression and symptom severity of AF, and it is also an indirect factor for systemic embolism [21,22]. Together with LVDD, silent AF can also coexist.…”

Section: Discussionmentioning

confidence: 99%

Analysis of echocardiographic parameters of cardiac function in patients with acute stroke

Lasek–Bal

Żak

Pysz

et al. 2019

Neurol Neurochir Pol.

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Introduction. Cardiologic diagnostics in stroke patients is designed to identify heart disease as a potential cause of stroke. The aim of this study was to evaluate the effect of low ejection fraction (EF) and left ventricular systolic/diastolic dysfunction (LVSD, LVDD) on the neurological state on the 1st day of stroke, as well as post-stroke functional status at 30 days after stroke. Patients and methods. For a prospective study, 162 stroke patients (mean age 74 years) were qualified. They were analysed according to neurological state on the 1st day of stroke, the results of transthoracic echocardiography, and functional status at 30 days after stroke. Results. The neurological state on the 1st day after stroke was significantly worse in patients with LVSD.

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Implication of Left Ventricular Diastolic Dysfunction in Cryptogenic Ischemic Stroke

Cited by 31 publications

References 39 publications

Clinical and echocardiographic characteristics of cardioembolic stroke

Clinical and echocardiographic characteristics of cardioembolic stroke

Left Ventricular Diastolic Dysfunction in Ischemic Stroke: Functional and Vascular Outcomes

Analysis of echocardiographic parameters of cardiac function in patients with acute stroke

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