Abstract TP385: Diastolic Function Of Heart And Outcomes After Ischemic Stroke
Background: Diastolic dysfunction (DD) has recently been shown to be a predictor of all-cause mortality in general population. Venticular stiffening and impaired relaxation are major pathophysiology of DD, and thus the patients with DD encounter exercise intolerance. We therefore hypothesized that the patients with DD are likely to have unfavorable outcome after ischemic stroke.
Method: We analyzed 503 consecutive ischemic stroke patients who underwent tissue Doppler echocardiography. DD profiles were consisted of peak mitral inflow velocity/mitral A-wave velocity, mitral deceleration time and peak mitral inflow velocity/diastolic tissue velocity (E/E’). Modified Rankin scale at 3months after stroke was used as a functional outcome. We performed logistic regression to examine the independent associations between DD profiles and outcomes. For sensitivity analyses, we reran regression in the settings of exclusion of patients with AF, exclusion of patients with previous stroke and exclusion of patients with coronary heart disease.
Results: The patients with unfavorable outcome had a greater E/E’ [dichotomized, favorable(n=390) vs. unfavorable(n=113), 11.0±4.6 vs. 16.4±7.9, p<0.001; responder analysis-defined outcome, favorable(n=240) vs. unfavorable(n=263), 10.6±3.3 vs. 13.7±7.4, p<0.001] In multivariable analyses, E/E’ was independently associated with responder-analyses defined unfavorable outcome. Dividing into quartile, the adjusted odd ratio(OR) for unfavorable outcome of the fourth quartile was 2.97[95% confidence interval(CI), 188.8.131.52] compared with the first quartile. When Q1-Q3 were collapsed as a single reference, adjusted OR of Q4 was 2.97(1.76-5.02). When we used a dichotomous outcome, this relationship became more robust. After dividing the patients according to the subtype of ischemic stroke, this relationship is consistent except for other-determined etiology; Q1-Q3 vs. Q4 adjusted OR ranged from 2.23 to 6.16. In sensitivity analyses, the impact of E/E’ on stroke outcome was materially unchanged.
Conclusion: Because E/E’ is best correlated with invasively-assessed diastolic function, our results suggested that diastolic dysfunction may hinder a functional regain following ischemic stroke.
- © 2012 by American Heart Association, Inc.