Left Ventricular Diastolic Dysfunction in Ischemic Stroke: Functional and Vascular Outcomes
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background and Purpose 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.
Abstract
Background and Purpose 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.
참고문헌 (27)
- Fischer M, "Prevalence of left ventricular diastolic dysfunction in the community. Results from a Doppler echocar diographic-based survey of a population sample", Eur Heart J, 24, pp.320~328 (2003)
- Kuznetsova T, "Prevalence of left ventricular diastolic dysfunction in a general population", Circ Heart Fail, 2, pp.105~112 (2009)
- Kloch-Badelek M, "Prevalence of left ventricular diastolic dysfunction in European populations based on cross-validated diagnostic thresholds", Cardiovasc Ultrasound, 10, pp.10~ (2012)
- Paulus WJ, "A novel paradigm for heart failure with preserved ejection fraction : comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation", J Am Coll Cardiol, 62, pp.263~271 (2013)
- Halley CM, "Mortality rate in patients with diastolic dysfunction and normal systolic function", Arch Intern Med, 171, pp.1082~1087 (2011)
- Kane GC, "Progression of left ventricular diastolic dysfunction and risk of heart failure", JAMA, 306, pp.856~863 (2011)
- Tsang TS, "Prediction of risk for first age-related cardiovascular events in an elderly population : the incremental value of echo-cardiography", J Am Coll Cardiol, 42, pp.1199~1205 (2003)
- O'Rourke MF, "Diastolic heart failure, diastolic left ventricular dysfunction and exercise intolerance", J Am Coll Cardiol, 38, pp.803~805 (2001)
- Seo JY, "Implication of left ventricular diastolic dysfunction in cryptogenic ischemic stroke", Stroke, 45, pp.2757~2761 (2014)
- 김범준, "Case Characteristics, Hyperacute Treatment, and Outcome Information from the Clinical Research Center for Stroke-Fifth Division Registry in South Korea", 대한뇌졸중학회지, 17(1), pp.38~53 (2015), 대한뇌졸중학회
- Kim BJ, "Current status of acute stroke management in Korea: a report on a multicenter, comprehensive acute stroke registry", Int J Stroke, 9, pp.514~518 (2014)
- Lang RM, "Recommendations for chamber quantification", Eur J Echocardiogr, 7, pp.79~108 (2006)
- Nagueh SF, "Recommendations for the evaluation of left ventricular diastolic function by echocardiography", Eur J Echocardiogr, 10, pp.165~193 (2009)
- Saver JL, "Novel end point analytic techniques and interpreting shifts across the entire range of outcome scales in acute stroke trials", Stroke, 38, pp.3055~3062 (2007)
- Damush TM, "Barriers and facilitators to exercise among stroke survivors", Rehabil Nurs, 32, pp.253~260 (2007)
- van Heerebeek L, "Low myocardial protein kinase G activity in heart failure with preserved ejection fraction", Circulation, 126, pp.830~839 (2012)
- Deswal A, "Diastolic dysfunction and diastolic heart failure : mechanisms and epidemiology", Curr Cardiol Rep, 7, pp.178~183 (2005)
- Westermann D, "Cardiac inflammation contributes to changes in the extracellular matrix in patients with heart failure and normal ejection fraction", Circ Heart Fail, 4, pp.44~52 (2011)
- Cumming TB, "Very early mobilization after stroke fast-tracks return to walking : further results from the phase ii avert randomized controlled trial", Stroke, 42, pp.153~158 (2011)
- Little WC, "Diastolic dysfunction as a cause of exercise intolerance", Heart Fail Rev, 5, pp.301~306 (2000)
- Gallanagh S, "Physical activity in the prevention and treatment of stroke", ISRN Neurol, 2011, pp.953818~ (2011)
- Shih JY, "Association of decreased left atrial strain and strain rate with stroke in chronic atrial fibrillation", J Am Soc Echocardiogr, 24, pp.513~519 (2011)
- AlJaroudi WA, "Prognostic value of diastolic dysfunction : state of the art review", Cardiol Rev, 22, pp.79~90 (2014)
- Kuwaki H, "Redefining diastolic dysfunction grading: Combination of E", A ≤ 0.75 and deceleration time >140 ms and E, JACC Cardiovasc Imaging, pp.2014, 7[DOI]
- Sohn DW, "Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function", J Am Coll Cardiol, 30, pp.474~480 (1997)
- Komajda M, "Heart failure with preserved ejection fraction : a clinical dilemma", Eur Heart J, 35, pp.1022~1032 (2014)
- Borlaug BA, "Exercise hemodynamics enhance diagnosis of early heart failure with preserved ejection fraction", Circ Heart Fail, 3, pp.588~595 (2010)