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Long-Term Outcomes of Real-World Korean Patients with Atrial-Fibrillation-Related Stroke and Severely Decreased Ejection Fraction

Title
Long-Term Outcomes of Real-World Korean Patients with Atrial-Fibrillation-Related Stroke and Severely Decreased Ejection Fraction
Authors
Jung, Jin-ManKim, Yong-HyunYu, SungwookO, KyungmiKim, Chi KyungSong, Tae-JinKim, Yong-JaeKim, Bum JoonHeo, Sung HyukPark, Kwang-YeolKim, Jeong-MinPark, Jong-HoChoi, Jay CholPark, Man-SeokKim, Joon-TaeChoi, Kang-HoHwang, Yang-HaChung, Jong-WonBang, Oh YoungKim, Gyeong-moonSeo, Woo-Keun
Ewha Authors
송태진
SCOPUS Author ID
송태진scopus
Issue Date
2019
Journal Title
JOURNAL OF CLINICAL NEUROLOGY
ISSN
1738-6586JCR Link

2005-5013JCR Link
Citation
JOURNAL OF CLINICAL NEUROLOGY vol. 15, no. 4, pp. 545 - 554
Keywords
atrial fibrillationstrokeechocardiographyoutcomes
Publisher
KOREAN NEUROLOGICAL ASSOC
Indexed
SCIE; SCOPUS; KCI WOS
Document Type
Article
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/e' ratio). LVEF was categorized into normal (>= 55%), mildly decreased (>40% and <55%), and severely decreased (<= 40%). The E/e' 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 (interquartile 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.
DOI
10.3988/jcn.2019.15.4.545
Appears in Collections:
의과대학 > 의학과 > Journal papers
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