Korean Circ J.  2018 Dec;48(12):1148-1156. 10.4070/kcj.2018.0115.

Left Ventricular Ejection Fraction Predicts Poststroke Cardiovascular Events and Mortality in Patients without Atrial Fibrillation and Coronary Heart Disease

• Lee JY
• Sunwoo JS
• Kwon KY
• Roh H
• Ahn MY
• Lee MH
• Park BW
• Hyon MS
• Lee KB

• KMID: 2424565
• DOI: http://doi.org/10.4070/kcj.2018.0115

Abstract

BACKGROUND AND OBJECTIVES
It is controversial that decreased left ventricular function could predict poststroke outcomes. The purpose of this study is to elucidate whether left ventricular ejection fraction (LVEF) can predict cardiovascular events and mortality in acute ischemic stroke (AIS) without atrial fibrillation (AF) and coronary heart disease (CHD).
METHODS
Transthoracic echocardiography was conducted consecutively in patients with AIS or transient ischemic attack at Soonchunhyang University Hospital between January 2008 and July 2016. The clinical data and echocardiographic LVEF of 1,465 patients were reviewed after excluding AF and CHD. Poststroke disability, major adverse cardiac events (MACE; nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death) and all-cause mortality during 1 year after index stroke were prospectively captured. Cox proportional hazards regressions analysis were applied adjusting traditional risk factors and potential determinants.
RESULTS
The mean follow-up time was 259.9±148.8 days with a total of 29 non-fatal strokes, 3 myocardial infarctions, 33 cardiovascular deaths, and 53 all-cause mortality. The cumulative incidence of MACE and all-cause mortality were significantly higher in the lowest LVEF ( < 55) group compared with the others (p=0.022 and 0.009). In prediction models, LVEF (per 10%) had hazards ratios of 0.54 (95% confidence interval [CI], 0.36-0.80, p=0.002) for MACE and 0.61 (95% CI, 0.39-0.97, p=0.037) for all-cause mortality.
CONCLUSIONS
LVEF could be an independent predictor of cardiovascular events and mortality after AIS in the absence of AF and CHD.

Keyword

Echocardiography; Stroke; Left ventricular function; Mortality

MeSH Terms

Atrial Fibrillation*
Coronary Disease*
Echocardiography
Follow-Up Studies
Humans
Incidence
Ischemic Attack, Transient
Mortality*
Myocardial Infarction
Prospective Studies
Risk Factors
Stroke
Stroke Volume*
Ventricular Function, Left

Figure

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  Figure 1 The distribution of LVEF in the subjects of this study. LVEF = left ventricular ejection fraction.

• 

  Figure 2 Cumulative incidence of MACE (A) and all-cause mortality (B) in LVEF subgroups. LVEF = left ventricular ejection fraction; MACE = major adverse cardiovascular events.

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