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

Research output: Contribution to journalArticle

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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Atrial Fibrillation
Stroke
Echocardiography
Heart Ventricles
Cause of Death
Registries
Confidence Intervals
Diastole
Heart Atria
Survivors
Hospitalization
Regression Analysis
Pressure

Keywords

  • Echocardiography
  • Outcomes
  • Stroke
  • ‌Atrial fibrillation

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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Long-term outcomes of real-world korean patients with atrial-fibrillation-related stroke and severely decreased ejection fraction. / Jung, Jin Man; Kim, Yong Hyun; Yu, Sungwook; O, Kyungmi; Kim, Chi Kyung; Song, Tae Jin; Kim, Yong Jae; Kim, Bum Joon; Heo, Sung Hyuk; Park, Kwang Yeol; Kim, Jeong Min; Park, Jong Ho; Choi, Jay Chol; Park, Man Seok; Kim, Joon Tae; Choi, Kang Ho; Hwang, Yang Ha; Chung, Jong Won; Bang, Oh Young; Kim, Gyeong Moon; Seo, Woo Keun.

In: Journal of Clinical Neurology (Korea), Vol. 15, No. 4, 10.2019, p. 545-554.

Research output: Contribution to journalArticle

Jung, JM, Kim, YH, Yu, S, O, K, Kim, CK, Song, TJ, Kim, YJ, Kim, BJ, Heo, SH, Park, KY, Kim, JM, Park, JH, Choi, JC, Park, MS, Kim, JT, Choi, KH, Hwang, YH, Chung, JW, Bang, OY, Kim, GM & Seo, WK 2019, 'Long-term outcomes of real-world korean patients with atrial-fibrillation-related stroke and severely decreased ejection fraction', Journal of Clinical Neurology (Korea), vol. 15, no. 4, pp. 545-554. https://doi.org/10.3988/jcn.2019.15.4.545
Jung, Jin Man ; Kim, Yong Hyun ; Yu, Sungwook ; O, Kyungmi ; Kim, Chi Kyung ; Song, Tae Jin ; Kim, Yong Jae ; Kim, Bum Joon ; Heo, Sung Hyuk ; Park, Kwang Yeol ; Kim, Jeong Min ; Park, Jong Ho ; Choi, Jay Chol ; Park, Man Seok ; Kim, Joon Tae ; Choi, Kang Ho ; Hwang, Yang Ha ; Chung, Jong Won ; Bang, Oh Young ; Kim, Gyeong Moon ; Seo, Woo Keun. / Long-term outcomes of real-world korean patients with atrial-fibrillation-related stroke and severely decreased ejection fraction. In: Journal of Clinical Neurology (Korea). 2019 ; Vol. 15, No. 4. pp. 545-554.
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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.",
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author = "Jung, {Jin Man} and Kim, {Yong Hyun} and Sungwook Yu and Kyungmi O and Kim, {Chi Kyung} and Song, {Tae Jin} and Kim, {Yong Jae} and Kim, {Bum Joon} and Heo, {Sung Hyuk} and Park, {Kwang Yeol} and Kim, {Jeong Min} and Park, {Jong Ho} and Choi, {Jay Chol} and Park, {Man Seok} and Kim, {Joon Tae} and Choi, {Kang Ho} and Hwang, {Yang Ha} and Chung, {Jong Won} and Bang, {Oh Young} and Kim, {Gyeong Moon} and Seo, {Woo Keun}",
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T1 - Long-term outcomes of real-world korean patients with atrial-fibrillation-related stroke and severely decreased ejection fraction

AU - Jung, Jin Man

AU - Kim, Yong Hyun

AU - Yu, Sungwook

AU - O, Kyungmi

AU - Kim, Chi Kyung

AU - Song, Tae Jin

AU - Kim, Yong Jae

AU - Kim, Bum Joon

AU - Heo, Sung Hyuk

AU - Park, Kwang Yeol

AU - Kim, Jeong Min

AU - Park, Jong Ho

AU - Choi, Jay Chol

AU - Park, Man Seok

AU - Kim, Joon Tae

AU - Choi, Kang Ho

AU - Hwang, Yang Ha

AU - Chung, Jong Won

AU - Bang, Oh Young

AU - Kim, Gyeong Moon

AU - Seo, Woo Keun

PY - 2019/10

Y1 - 2019/10

N2 - 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.

AB - 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.

KW - Echocardiography

KW - Outcomes

KW - Stroke

KW - ‌Atrial fibrillation

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