Abstract T P291: Impact of Diastolic Dysfunction for Predicting Mortality in Ischemic Stroke and Transient Ischemic Attack Patients

Abstract

Background: The aim of this study is to identify whether diastolic dysfunction predicts 90-day mortality and develop and validate a risk score model using information available at hospital presentation in ischemic stroke or transient ischemic attack (TIA) patients Methods: Consecutive ischemic stroke or TIA patients within 48 hours of onset were enrolled. Diastolic filling pressure was estimated as the ratio of early transmitral flow velocity (E) to mitral annular velocity (e’) on transthoracic echocardiography performed within 24 hours of presentation. Plasma brain natriuretic peptide (BNP) and D-dimer were measured on admission. We calculated initial diffusion weighted imaging (DWI) lesion volume. Stroke severity was assessed by the National Institute of Health Stroke Scale (NIHSS) score. Mortality was evaluated at 90-day follow-up. Univariate and multivariate analyses were conducted to identify predictors of 90-day mortality. Results: A total of 265 patients with ischemic stroke or TIA were enrolled. Of these, nineteen (7%) patients deceased at 90-day follow-up. At univariate analysis, higher age (p=0.002), atrial fibrillation (p<0.001), use of antiplatelet agent (p=0.005) and anticoagulant agent (p=0.017), cardioembolic infarction (p<0.001), higher NIHSS score (p<0.001), larger DWI lesion volume (p=0.002), internal carotid artery occlusion (p<0.001), higher E/e’ (p<0.001), PT-INR level (p=0.004), BNP level (p<0.001) and D-dimer level (p<0.001) and lower albumin level (p=0.002) were associated with death. Multivariable predictors of 90-day mortality included higher E/e’ (Odds ratio [OR]=1.176; 95% confidence interval [CI], 1.051 to 1.317), NIHSS score (OR=1.180; 95% CI, 1.067- 1.306) and D-dimer level (OR=1.137; 95% CI, 1.009 to 1.281). The END score (1 point each for E/e’ of >= 18.5, NIHSS score of >= 17 and D-dimer level of >= 2.0) stratified patients with a predicted probability of death rate from 0% to 77.8%. The c statistic was 0.947. Conclusions: Diastolic dysfunction could be one of the most important predictors of 90-day mortality of acute ischemic stroke and TIA. The END score may assist clinicians in estimating stroke mortality at hospital presentation.