Long-term outcomes of real-world korean patients with atrial-fibrillation-related stroke and severely decreased ejection fraction

Jin Man Jung, Yong Hyun Kim, Sungwook Yu, Kyungmi O, Chi Kyung Kim, Tae Jin Song, Yong Jae Kim, Bum Joon Kim, Sung Hyuk Heo, Kwang Yeol Park, Jeong Min Kim, Jong Ho Park, Jay Chol Choi, Man Seok Park, Joon Tae Kim, Kang Ho Choi, Yang Ha Hwang, Jong Won Chung, Oh Young Bang, Gyeong Moon KimWoo Keun Seo

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Abstract

Background and Purpose The clinical implications of echocardiography findings for long-term outcomes in atrial fibrillation (AF)-related stroke patients are unknown. Methods This was a substudy of the Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts (K-ATTENTION), which is a multicenter-based cohort comprising prospective stroke registries from 11 tertiary centers. Stroke survivors who underwent two-dimensional transthoracic echocardiography during hospitalization were enrolled. Echocardiography markers included the left-ventricle (LV) ejection fraction (LVEF), the left atrium diameter, and the ratio of the peak transmitral filling velocity to the mean mitral annular velocity during early diastole (E/eʹ ratio). LVEF was categorized into normal (≥55%), mildly decreased (>40% and <55%), and severely decreased (≤40%). The E/eʹ ratio associated with the LV filling pressure was categorized into normal (<8), borderline (≥8 and <15), and elevated (≥15). Kaplan-Meier and Cox regression analyses were performed for recurrent stroke, major adverse cardiac events, and all-cause death. Results This study finally included 1,947 patients. Over a median follow-up of 1.65 years (in-terquartile range, 0.42–2.87 years), the rates of recurrent stroke, major adverse cardiac events, and all-cause death were 35.1, 10.8, and 69.6 cases per 1,000 person-years, respectively. Multivariable analyses demonstrated that severely decreased LVEF was associated with a higher risks of major adverse cardiac events [hazard ratio (HR), 3.91; 95% confidence interval (CI), 1.58–9.69] and all-cause death (HR, 1.95; 95% CI, 1.23–3.10). The multivariable fractional polynomial plot indicated that recurrent stroke might be associated with a lower LVEF. Conclusions Severe LV systolic dysfunction could be a determinant of long-term outcomes in AF-related stroke.

Original languageEnglish
Pages (from-to)545-554
Number of pages10
JournalJournal of Clinical Neurology (Korea)
Volume15
Issue number4
DOIs
Publication statusPublished - 2019 Oct

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Keywords

  • Echocardiography
  • Outcomes
  • Stroke
  • ‌Atrial fibrillation

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Jung, J. M., Kim, Y. H., Yu, S., O, K., Kim, C. K., Song, T. J., Kim, Y. J., Kim, B. J., Heo, S. H., Park, K. Y., Kim, J. M., Park, J. H., Choi, J. C., Park, M. S., Kim, J. T., Choi, K. H., Hwang, Y. H., Chung, J. W., Bang, O. Y., ... Seo, W. K. (2019). Long-term outcomes of real-world korean patients with atrial-fibrillation-related stroke and severely decreased ejection fraction. Journal of Clinical Neurology (Korea), 15(4), 545-554. https://doi.org/10.3988/jcn.2019.15.4.545