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Research Article| Volume 345, ISSUE 1-2, P83-86, October 15, 2014

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Cardiac diastolic dysfunction predicts in-hospital mortality in acute ischemic stroke with atrial fibrillation

      Highlights

      • We assessed diastolic dysfunction in ischemic stroke with AF.
      • We defined diastolic dysfunction as a high E/e′ on transthoracic echocardiography.
      • High E/e′ predicted in-hospital death in ischemic stroke patients with AF.

      Abstract

      Background

      The aim of this study was to identify whether diastolic dysfunction predicts in-hospital death in ischemic stroke patients with atrial fibrillation.

      Method

      We retrospectively analyzed data from enrolled patients with ischemic stroke patients with atrial fibrillation who presented within 24 h of onset. All patients underwent transthoracic echocardiography to evaluate diastolic filling pressure estimated as the ratio of early transmitral flow velocity (E) to mitral annular velocity (e′) within 24 h of admission. We evaluated initial ischemic lesion volume and National Institute of Health Stroke Scale (NIHSS) score.

      Results

      Two hundred and sixty-six patients were enrolled. During hospitalization, 30 patients (11%) died. The deceased group had a higher NIHSS score, a higher D-dimer level, a higher creatinine level, a larger initial ischemic lesion volume and a higher E/e′ ratio than those in the survival group. In a multivariate analysis, a higher E/e′ ratio was an independent predictor of in-hospital death. The cutoff value for the E/e′ ratio for prediction in-hospital death was 20 with the sensitivity of 75% and specificity of 86%.

      Conclusion

      Diastolic dysfunction may be associated with in-hospital death in ischemic stroke patients with atrial fibrillation.

      Keywords

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      References

        • Jørgensen H.S.
        • Nakayama H.
        • Reith J.
        • Raaschou H.O.
        • Olsen T.S.
        Acute stroke with atrial fibrillation. The Copenhagen Stroke Study.
        Stroke. 1996; 27: 1765-1769
        • Wolf P.A.
        • Mitchell J.B.
        • Baker C.S.
        • Kannel W.B.
        • D'Agostino R.B.
        Impact of atrial fibrillation on mortality, stroke, and medical costs.
        Arch Intern Med. 1998; 158: 229-234
        • Gattellari M.
        • Goumas C.
        • Aitken R.
        • Worthington J.M.
        Outcomes for patients with ischaemic stroke and atrial fibrillation: the PRISM study (A Program of Research Informing Stroke Management).
        Cerebrovasc Dis. 2011; 32: 370-382
        • Kimura K.
        • Minematsu K.
        • Yamaguchi T.
        Atrial fibrillation as a predictive factor for severe stroke and early death in 15,831 patients with acute ischaemic stroke.
        J Neurol Neurosurg Psychiatry. 2005; 76: 679-683
        • Saxena R.
        • Lewis S.
        • Berge E.
        • Sandercock P.A.
        • Koudstaal P.J.
        Risk of early death and recurrent stroke and effect of heparin in 3169 patients with acute ischemic stroke and atrial fibrillation in the International Stroke Trial.
        Stroke. 2001; 32: 2333-2337
        • Shibazaki K.
        • Kimura K.
        • Iguchi Y.
        • Aoki J.
        • Sakai K.
        • Kobayashi K.
        Plasma brain natriuretic peptide predicts death during hospitalization in acute ischaemic stroke and transient ischaemic attack patients with atrial fibrillation.
        Eur J Neurol. 2011; 18: 165-169
        • Inouye I.
        • Massie B.
        • Loge D.
        • Topic N.
        • Silverstein D.
        • Simpson P.
        • et al.
        Abnormal left ventricular filling: an early finding in mild to moderate systemic hypertension.
        Am J Cardiol. 1984; 53: 120-126
        • Fouad F.M.
        • Slominski J.M.
        • Tarazi R.C.
        Left ventricular diastolic function in hypertension: relation to left ventricular mass and systolic function.
        J Am Coll Cardiol. 1984; 3: 1500-1506
        • Halley C.M.
        • Houghtaling P.L.
        • Khalil M.K.
        • Thomas J.D.
        • Jaber W.A.
        Mortality rate in patients with diastolic dysfunction and normal systolic function.
        Arch Intern Med. 2011; 171: 1082-1087
        • Aljaroudi W.
        • Alraies M.C.
        • Halley C.
        • Rodriguez L.
        • Grimm R.A.
        • Thomas J.D.
        • et al.
        Impact of progression of diastolic dysfunction on mortality in patients with normal ejection fraction.
        Circulation. 2012; 125: 782-788
        • Jang S.-J.
        • Kim M.-S.
        • Park H.-J.
        • Han S.
        • Kang D.-H.
        • Song J.-K.
        • et al.
        Impact of heart failure with normal ejection fraction on the occurrence of ischaemic stroke in patients with atrial fibrillation.
        Heart. 2013; 99: 17-21
        • Fiorelli M.
        • Bastianello S.
        • von Kummer R.
        • del Zoppo G.J.
        • Larrue V.
        • Lesaffre E.
        • et al.
        Hemorrhagic transformation within 36 hours of a cerebral infarct: relationships with early clinical deterioration and 3-month outcome in the European Cooperative Acute Stroke Study I (ECASS I) cohort.
        Stroke. 1999; 30: 2280-2284
        • Okura H.
        • Takada Y.
        • Kubo T.
        • Iwata K.
        • Mizoguchi S.
        • Taguchi H.
        • et al.
        Tissue Doppler-derived index of left ventricular filling pressure, E/E′, predicts survival of patients with non-valvular atrial fibrillation.
        Heart. 2006; 92: 1248-1252
        • Iwakura K.
        • Okamura A.
        • Koyama Y.
        • Date M.
        • Higuchi Y.
        • Inoue K.
        • et al.
        Effect of elevated left ventricular diastolic filling pressure on the frequency of left atrial appendage thrombus in patients with nonvalvular atrial fibrillation.
        Am J Cardiol. 2011; 107: 417-422
        • Palmieri V.
        • Russo C.
        • Palmieri E.A.
        • Arezzi E.
        • Pezzullo S.
        • Minichiello S.
        • et al.
        Isolated left ventricular diastolic dysfunction: implications for exercise left ventricular performance in patients without congestive heart failure.
        J Am Soc Echocardiogr. 2006; 19: 491-498
        • Divani A.A.
        • Vazquez G.
        • Asadollahi M.
        • Qureshi A.I.
        • Pullicino P.
        Nationwide frequency and association of heart failure on stroke outcomes in the United States.
        J Card Fail. 2009; 15: 11-16
        • Arenillas J.F.
        • Rovira A.
        • Molina C.A.
        • Grivé E.
        • Montaner J.
        • Alvarez-Sabín J.
        Prediction of early neurological deterioration using diffusion- and perfusion-weighted imaging in hyperacute middle cerebral artery ischemic stroke.
        Stroke. 2002; 33: 2197-2203
        • Keyzer J.M.
        • Hoffmann J.J.
        • Ringoir L.
        • Nabbe K.C.
        • Widdershoven J.W.
        • Pop V.J.
        Age- and gender-specific brain natriuretic peptide (BNP) reference ranges in primary care.
        Clin Chem Lab Med. 2014; (in press)
        • Idicula T.T.
        • Waje-Andreassen U.
        • Brogger J.
        • Naess H.
        • Thomassen L.
        Serum albumin in ischemic stroke patients: the higher the better. The Bergen Stroke Study.
        Cerebrovasc Dis. 2009; 28: 13-17
        • Rallidis L.S.
        • Vikelis M.
        • Panagiotakos D.B.
        • Liakos G.K.
        • Krania E.
        • Kremastinos D.T.
        Usefulness of inflammatory and haemostatic markers to predict short-term risk for death in middle-aged ischaemic stroke patients.
        Acta Neurol Scand. 2008; 117: 415-420
        • Nardi K.
        • Milia P.
        • Eusebi P.
        • Paciaroni M.
        • Caso V.
        • Agnelli G.
        Predictive value of admission blood glucose level on short-term mortality in acute cerebral ischemia.
        J Diabetes Complications. 2012; 26: 70-76
        • Smith E.E.
        • Shobha N.
        • Dai D.
        • Olson D.M.
        • Reeves M.J.
        • Saver J.L.
        • et al.
        Risk score for in-hospital ischemic stroke mortality derived and validated within the Get With the Guidelines-Stroke Program.
        Circulation. 2010; 122: 1496-1504
        • Fonarow G.C.
        • Pan W.
        • Saver J.L.
        • Smith E.E.
        • Reeves M.J.
        • Broderick J.P.
        • et al.
        Comparison of 30-day mortality models for profiling hospital performance in acute ischemic stroke with vs without adjustment for stroke severity.
        JAMA. 2012; 308: 257-264