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Echocardiographic parameters determining cardiovascular outcomes in patients after acute ischemic stroke

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Abstract

Previous studies have focused on only 1 or 2 echocardiographic parameters as prognostic markers in patients with acute ischemic stroke (AIS). A total of 900 patients with AIS who underwent transthoracic echocardiography (72.6 ± 12.0 years and 60% males) were retrospectively reviewed. Composite clinical events, including all-cause mortality, non-fatal stroke, non-fatal myocardial infarction, and coronary revascularization, were assessed during clinical follow-ups. During a median follow-up of 3.3 years (interquartile range 0.6–5.1 years), there were 151 (16.8%) composite events. In the multivariable analyses after controlling for potential confounders, left ventricular ejection fraction (LVEF) < 62% (hazard ratio [HR] 1.62; 95% confidence interval [CI] 1.14–2.30; p = 0.007) and AV sclerosis (AVs) (HR 1.56; 95% CI 1.10–2.21; p = 0.013) were independent prognostic factors associated with composite events. Multivariable analyses showed that HR for composite events gradually increased according to LVEF and AVs: HR was 2.6-fold higher in the highest-risk group than in the lowest group (p < 0.001). Compared with a clinical model (global chi-square = 69.6), LVEF, AVs, and both of them were significantly improved outcome prediction in sequential Cox model analysis (global chi-square = 75.6, 75.7, and 78.8, respectively; p < 0.05 for each) for each. In patients with AIS, LVEF < 62%, and the presence of AV sclerosis can predict future vascular events. Patients with AIS exhibiting reduced LVEF and AV sclerosis may benefit from aggressive secondary prevention.

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Author notes

  1. Minkwan Kim and Hack-Lyoung Kim have equally contributed to this work.

Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, 5 Boramae-ro, Dongjak-gu, Seoul, 07061, Korea

    Minkwan Kim, Hack-Lyoung Kim, Kyung-Taek Park, You Nui Kim, Woo-Hyun Lim, Jae-Bin Seo, Sang-Hyun Kim, Myung-A. Kim & Joo-Hee Zo

  2. Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Korea

    Minkwan Kim

  3. Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea

    Jae-Sung Lim

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  1. Minkwan Kim
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Kim, M., Kim, HL., Park, KT. et al. Echocardiographic parameters determining cardiovascular outcomes in patients after acute ischemic stroke. Int J Cardiovasc Imaging 36, 1445–1454 (2020). https://doi.org/10.1007/s10554-020-01841-5

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