Diastolic Dysfunction as a Positive Predictor of Recurrent Vascular Events in Patients With Noncardioembolic Stroke

Stroke. 2024 Mar;55(3):595-603. doi: 10.1161/STROKEAHA.123.042548. Epub 2024 Feb 8.

Abstract

Background: This study aimed to assess the effects of left ventricular diastolic dysfunction (LVDD) on vascular outcomes among patients with stroke of noncardioembolic origins.

Methods: This prospective observational study enrolled 563 patients with noncardioembolic stroke (mean age, 67.9 years; 66.7% men and 33.3% women individuals) registered in the Tokyo Women's Medical University Stroke Registry between 2013 and 2020. Then, patients were divided into the LVDD and non-LVDD groups. The primary outcome was a composite of major adverse cardiovascular events, including nonfatal stroke, nonfatal acute coronary syndrome, and vascular death 1 year after stroke onset. The effect of LVDD on vascular events was assessed using multivariable Cox regression analyses.

Results: A total of 130 (23.1%) patients had any grade of LVDD, and patients with LVDD had a higher risk of major adverse cardiovascular event at 1 year than those without LVDD (annual rate, 20.9% versus 10.8%; log-rank P=0.001). The multivariable Cox proportional hazards regression model demonstrated that the presence of LVDD was independently associated with the major adverse cardiovascular event risk (hazard ratio, 1.79 [95% CI, 1.02-3.12]; P=0.019). Furthermore, the LVDD grade was proportional to the risk of major adverse cardiovascular events and recurrent stroke.

Conclusions: LVDD may be associated with further vascular events after a noncardioembolic stroke, suggesting the importance of LVDD evaluations in risk stratification and secondary prevention in patients with noncardioembolic stroke.

Registration: URL: https://upload.umin.ac.jp; Unique identifier: UMIN000031913.

Keywords: atrial fibrillation; coronary artery disease; humans; ischemic stroke; physical exertion.

Publication types

  • Observational Study

MeSH terms

  • Acute Coronary Syndrome*
  • Aged
  • Female
  • Humans
  • Male
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • Stroke* / epidemiology
  • Stroke* / prevention & control

Associated data

  • ClinicalTrials.gov/UMIN000031913