MPS 16-01 Left Ventricular Geometry Determines Prognosis and U-shaped Relation between Blood Pressure and Mortality in Ischemic Stroke Patients

Abstract

Objective: The left ventricular (LV) geometry is well-known prognosticators in various populations. However, there are no data on their role in ischemic stroke patients. We sought to investigate the prognostic significance of LV geometry in ischemic stroke survivors, and the LV geometry-specific differences in blood pressure-mortality relationship. Design and Method: We prospectively recruited 2,328 consecutive patients admitted with acute ischemic stroke to our institute between 2002 and 2010. Of these, 2,069 patients were analyzed, in whom echocardiographic data were available to assess LV geometry. Results: All-cause mortality was significantly greater in concentric hypertrophy (adjusted hazard ratio [HR], 1.451; 95% confidence interval [CI], 1.075 to 1.960) and concentric remodelling (HR, 1.581; 95% CI, 1.147 to 2.179), but marginally higher in eccentric hypertrophy (HR, 1.354; 95% CI, 0.974 to 1.883) than normal geometry in multivariate analyses. Relative wall thickness (RWT) and LV mass index (LVMi) were significantly or marginally associated with all-cause mortality (HR, 1.165, per 0.1U increase in RWT; 95% CI, 1.033 to 1.314 and HR, 1.004, per 1 g/m2 increase in LVMi; 95% CI, 1.000 to 1.007, respectively). Similar results were observed with vascular mortality. In multivariable fractional polynomials, patients with altered LV geometry showed U-curve relationships between acute-phase systolic blood pressure and all-cause or vascular mortality with highest risk in lower extremes, whereas those with normal geometry did not. Conclusions: Echocardiographic assessment for LV geometry provided independent prognostic information in ischemic stroke patients. The U-shaped relation of mortality with blood pressure was found in patients with abnormal LV geometry.Figure