Abstract WP188: Cardiac Diastolic Dysfunction Is Associated With Poor Functional Outcome In Ischemic Stroke Patients

Abstract

Background and Purpose: Some studies reported that cardiac diastolic dysfunction was related to poor prognosis in heart failure, however, its relationship with acute stroke has not yet been clear. We assessed the hypothesis that cardiac diastolic dysfunction may affect the outcome in acute ischemic stroke patients. Methods: Among 938 consecutive acute stroke patients admitted to Steel Memorial Yawata Hospital, Kitakyushu, Japan within 7 days after the symptom onset from January 2008 to March 2012, 460 patients with ischemic lesions on the initial diffusion-weighted image, prior modified Rankin scale (mRS) of 0 or 1, and available E/E’ values (one of the parameters of cardiac diastolic function in transthoracic echocardiography) evaluated after admission were included into the final statistical analysis. Patients were divided into quartiles according to E/E’ values; Q1 (less than 10), Q2 (10-13), Q3 (14-15), Q4 (more than 15). A NIH stroke scale score worsening of ≥1-point during the first 21 hospital days was defined as an acute neurological deterioration. A modified Rankin scale (mRS) of 2 or more was defined as a poor outcome. We also observed stroke recurrence or any death during one year from the onset. Results: Age (p<0.0001), frequency of female (p<0.0001), initial NIH stroke scale score (p=0.0184), and frequency of diabetes mellitus (p=0.0304), hypertension (p=0.0344), and severe valvular heart diseases (p=0.0008) showed a stepwise increase in Q1-Q4 in order. A poor outcome 3 months after the onset was observed in 15%, 27%, 24%, and 49% in the Q1-4 patients respectively. A stroke recurrence or any death occurred in 6%, 11%, 11%, and 17% in the Q1-4 patients respectively. On the multivariate logistic regression analysis, the worst E/E’ grade (Q4) was independently associated with a poor outcome 3 months after the onset (Odds Ratio 2.7; 95% CI 1.01-7.14; p=0.0463) and stroke recurrence or any death (Odds Ratio 5.2; 95% CI 1.59-18.9; p=0.0058), however, it was not associated with an acute neurological deterioration and a poor outcome on the discharge. Conclusions: Severe cardiac diastolic dysfunction might be associated with a poor outcome and long-term stroke recurrence in ischemic stroke patients.