Long-Term Outcomes of Real-World Korean Patients with Atrial-Fibrillation-Related Stroke and Severely Decreased Ejection Fraction
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Background and Purpose Te clinical implications of echocardiography fndings for longterm outcomes in atrial fbrillation (AF)-related stroke patients are unknown. Methods Tis was a substudy of the Korean ATrial fbrillaTion EvaluatioN regisTry in Ischemic strOke patieNts (K-ATTENTION), which is a multicenter-based cohort comprising prospective stroke registries from 11 tertiary centers. Stroke survivors who underwent twodimensional transthoracic echocardiography during hospitalization were enrolled. Echocardiography markers included the lef-ventricle (LV) ejection fraction (LVEF), the lef atrium diameter, and the ratio of the peak transmitral flling velocity to the mean mitral annular velocity during early diastole (E/eʹ ratio). LVEF was categorized into normal (≥55%), mildly decreased (>40% and <55%), and severely decreased (≤40%). Te E/eʹ ratio associated with the LV flling pressure was categorized into normal (<8), borderline (≥8 and <15), and elevated (≥15). Kaplan-Meier and Cox regression analyses were performed for recurrent stroke, major adverse cardiac events, and all-cause death. Results Tis study fnally included 1,947 patients. Over a median follow-up of 1.65 years (interquartile range, 0.42–2.87 years), the rates of recurrent stroke, major adverse cardiac events, and all-cause death were 35.1, 10.8, and 69.6 cases per 1,000 person-years, respectively. Multivariable analyses demonstrated that severely decreased LVEF was associated with a higher risks of major adverse cardiac events [hazard ratio (HR), 3.91; 95% confdence interval (CI), 1.58–9.69] and all-cause death (HR, 1.95; 95% CI, 1.23–3.10). Te multivariable fractional polynomial plot indicated that recurrent stroke might be associated with a lower LVEF. Conclusions Severe LV systolic dysfunction could be a determinant of long-term outcomes in AF-related stroke.
Abstract
Background and Purpose Te clinical implications of echocardiography fndings for longterm outcomes in atrial fbrillation (AF)-related stroke patients are unknown. Methods Tis was a substudy of the Korean ATrial fbrillaTion EvaluatioN regisTry in Ischemic strOke patieNts (K-ATTENTION), which is a multicenter-based cohort comprising prospective stroke registries from 11 tertiary centers. Stroke survivors who underwent twodimensional transthoracic echocardiography during hospitalization were enrolled. Echocardiography markers included the lef-ventricle (LV) ejection fraction (LVEF), the lef atrium diameter, and the ratio of the peak transmitral flling velocity to the mean mitral annular velocity during early diastole (E/eʹ ratio). LVEF was categorized into normal (≥55%), mildly decreased (>40% and <55%), and severely decreased (≤40%). Te E/eʹ ratio associated with the LV flling pressure was categorized into normal (<8), borderline (≥8 and <15), and elevated (≥15). Kaplan-Meier and Cox regression analyses were performed for recurrent stroke, major adverse cardiac events, and all-cause death. Results Tis study fnally included 1,947 patients. Over a median follow-up of 1.65 years (interquartile range, 0.42–2.87 years), the rates of recurrent stroke, major adverse cardiac events, and all-cause death were 35.1, 10.8, and 69.6 cases per 1,000 person-years, respectively. Multivariable analyses demonstrated that severely decreased LVEF was associated with a higher risks of major adverse cardiac events [hazard ratio (HR), 3.91; 95% confdence interval (CI), 1.58–9.69] and all-cause death (HR, 1.95; 95% CI, 1.23–3.10). Te multivariable fractional polynomial plot indicated that recurrent stroke might be associated with a lower LVEF. Conclusions Severe LV systolic dysfunction could be a determinant of long-term outcomes in AF-related stroke.
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