Left Ventricular Diastolic Dysfunction with Elevated Filling Pressures Is Associated with Embolic Stroke of Undetermined Source and Atrial Fibrillation
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Acquisition
2.2. Patient Population
2.3. Patient Characteristics
2.4. Definition of LVDD and Elevated LVFP
2.5. Outcome
2.6. Statistical Analysis
3. Results
3.1. General Characteristics
3.2. ESUS Association with LVDD and LVFP
3.3. AF Detection Association with LVDD and LVFP
4. Discussion
Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | No LVDD (n = 353) | LVDD (n = 156) | p Value |
---|---|---|---|
Age (mean ± SD) | 60.88 ± 14.17 | 71.69 ± 12.31 | <0.001 |
Sex (% female) | 157/353 (44.5%) | 73/156 (46.8%) | 0.628 |
Hypertension (%) | 207/352 (58.8%) | 127/155 (81.9%) | <0.001 |
Diabetes (%) | 75/352 (21.3%) | 51/155 (32.9%) | 0.005 |
Hyperlipidemia (%) | 129/351 (36.8%) | 88/155 (56.8%) | <0.001 |
Coronary Artery Disease (%) | 37/353 (10.5%) | 37/155 (23.9%) | <0.001 |
Congestive Heart Failure (%) * | 2/352 (0.6%) | 10/155 (6.5%) | <0.001 |
Renal Disease (%) | 15/352 (4.3%) | 13/155 (8.4%) | 0.061 |
Active Tobacco Use (%) | 99/277 (35.7%) | 23/96 (24.0%) | 0.034 |
Left Atrial Dilation (%) | 18/344 (5.2%) | 39/128 (30.5%) | <0.001 |
Systolic Blood Pressure | 146.03 ± 27.04 | 154.29 ± 28.69 | 0.003 |
NIHSS (median, IQR) | 7 (3–16) | 9 (4–17) | 0.121 |
ESUS Stroke (%) | 141/353 (39.9%) | 88/156 (56.4%) | 0.001 |
NCE Stroke (%) | 212/353 (60.1%) | 68/156 (43.6%) | 0.001 |
Atrial Fibrillation Detection (%) | 17/228 (7.5%) | 17/103 (16.5%) | 0.012 |
Wall Motion Abnormalities (%) | 29/338 (8.6%) | 39/139 (28.1%) | <0.001 |
Tricuspid Regurgitation Velocity Max (median, IQR) | 2.38 (2.17–2.57) | 2.51 (2.27–2.86) | <0.001 |
Left Ventricular Ejection Fraction (median, IQR) | 65 (60–67) | 65 (55–69) | 0.042 |
Left Atrial Volume (median, IQR) | 36 (25–44) | 38 (29.5–55) | 0.287 |
Left Atrial Volume Index (median, IQR) | 17 (13–22.5) | 19.5 (15–27) | 0.205 |
Mitral Valve E/A Ratio (median, IQR) | 0.97 (0.76–1.2) | 0.84 (0.72–1.09) | 0.003 |
Mitral Valve E/E′ Ratio Septal (median, IQR) | 10.38 (8.5–12.62) | 14.62 (10.78–18.38) | <0.001 |
Mitral Valve E/E′ Ratio Lateral (median, IQR) | 7.9 (6.23–9.75) | 11.85 (8.91–15.32) | <0.001 |
Mitral Valve E/E′ Ratio Mean (median, IQR) | 8.95 (7.31–10.92) | 12.89 (9.86–16.17) | <0.001 |
Variable | No LVDD (n = 353) | LVDD with Normal LVFP (n = 80) | LVDD with Elevated LVFP (n = 66) | p Value |
---|---|---|---|---|
Age (mean ± SD) | 60.88 ± 14.17 | 69.81 ± 11.65 | 74.58 ± 12.45 | 0.062 |
Sex (% female) | 157/353 (44.5%) | 30/80 (37.5%) | 39/66 (59.1%) | 0.028 |
Hypertension (%) | 207/352 (58.8%) | 59/79 (74.7%) | 59/66 (89.4%) | <0.001 |
Diabetes (%) | 75/352 (21.3%) | 23/79 (29.1%) | 23/66 (34.8%) | 0.035 |
Hyperlipidemia (%) | 129/351 (36.8%) | 39/79 (49.4%) | 42/66 (63.6%) | <0.001 |
Coronary Artery Disease (%) | 37/353 (10.5%) | 15/79 (19.0%) | 19/66 (28.8%) | <0.001 |
Congestive Heart Failure (%) * | 2/352 (0.6%) | 3/79 (3.8%) | 7/66 (10.6%) | <0.001 |
Renal Disease (%) | 15/352 (4.3%) | 5/79 (6.3%) | 7/66 (10.6%) | 0.105 |
Active Tobacco Use (%) | 99/277 (35.7%) | 15/48 (31.3%) | 8/44 (18.2%) | 0.068 |
Left Atrial Dilation (%) | 18/344 (5.2%) | 7/76 (9.2%) | 29/45 (64.4%) | <0.001 |
Systolic Blood Pressure | 146.03 ± 27.04 | 151.34 ± 27.21 | 158.03 ± 30.26 | 0.491 |
NIHSS (median, IQR) | 7 (3–16) | 7 (4–17) | 11 (4.5–17) | 0.019 |
ESUS Stroke (%) | 141/353 (39.9%) | 34/80 (42.5%) | 45/66 (68.2%) | <0.001 |
NCE Stroke (%) | 212/353 (60.1%) | 46/80 (57.5%) | 21/66 (31.8%) | <0.001 |
Atrial Fibrillation Detection (%) | 17/228 (7.5%) | 5/43 (11.6%) | 12/51 (23.5%) | 0.003 |
Wall Motion Abnormalities (%) | 29/338 (8.6%) | 20/75 (26.7%) | 16/54 (29.6%) | <0.001 |
Tricuspid Regurgitation Velocity Max (median, IQR) | 2.38 (2.17–2.57) | 2.4 (2.21–2.63) | 2.77 (2.4–2.96) | <0.001 |
Left Ventricular Ejection Fraction (median, IQR) | 65 (60–67) | 65 (55–69) | 62 (55–70) | 0.149 |
Left Atrial Volume (median, IQR) | 36 (25–44) | 34 (20–43) | 43 (36–57) | 0.018 |
Left Atrial Volume Index (median, IQR) | 17 (13–22.5) | 16 (12–21) | 21 (19–33) | 0.006 |
Mitral Valve E/A Ratio (median, IQR) | 0.97 (0.76–1.2) | 0.75 (0.67–0.84) | 1.04 (0.85–1.27) | <0.001 |
Mitral Valve E/E′ Ratio Septal (median, IQR) | 10.38 (8.5–12.62) | 12 (9.47–14.62) | 17.8 (15.4–19.5) | <0.001 |
Mitral Valve E/E′ Ratio Lateral (median, IQR) | 7.9 (6.23–9.75) | 9.47 (8–11.9) | 14.7 (12.74–17.7) | <0.001 |
Mitral Valve E/E′ Ratio Mean (median, IQR) | 8.95 (7.31–10.92) | 10.38 (8.53–12.89) | 15.68 (14–18.29) | <0.001 |
No LVDD | LVDD | |
---|---|---|
ESUS | ||
Unadjusted OR (95% CI) | Reference | 1.95 (1.33–2.85) p < 0.001 |
Adjusted † OR (95% CI) | Reference | 1.43 (0.90–2.27) p = 0.130 |
AF Detection | ||
Unadjusted OR (95% CI) | Reference | 2.72 (1.14–6.48) p = 0.024 |
Adjusted † OR (95% CI) | Reference | 1.88 (0.75–4.72) p = 0.179 |
No LVDD | LVDD with Normal LVFP | LVDD with Elevated LVFP | |
---|---|---|---|
ESUS | |||
Unadjusted OR (95% CI) | Reference | 1.11 (0.68–1.82) p = 0.674 | 3.22 (1.84–5.64) p < 0.001 |
Adjusted § OR (95% CI) | Reference | 1.03 (0.61–1.77) p = 0.903 | 2.17 (0.99–4.77) p = 0.054 |
AF Detection | |||
Unadjusted OR (95% CI) | Reference | 1.63 (0.52–5.10) p = 0.403 | 5.86 (1.89–18.17) p = 0.002 |
Adjusted § OR (95% CI) | Reference | 1.30 (0.40–4.20) p = 0.658 | 3.95 (1.07–12.06) p = 0.038 |
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Bashir, Z.; Shu, L.; Guo, Y.; Chen, E.W.; Wang, S.; Goldstein, E.D.; Rana, M.; Kala, N.; Dai, X.; Mandel, D.; et al. Left Ventricular Diastolic Dysfunction with Elevated Filling Pressures Is Associated with Embolic Stroke of Undetermined Source and Atrial Fibrillation. Tomography 2024, 10, 1694-1705. https://doi.org/10.3390/tomography10100124
Bashir Z, Shu L, Guo Y, Chen EW, Wang S, Goldstein ED, Rana M, Kala N, Dai X, Mandel D, et al. Left Ventricular Diastolic Dysfunction with Elevated Filling Pressures Is Associated with Embolic Stroke of Undetermined Source and Atrial Fibrillation. Tomography. 2024; 10(10):1694-1705. https://doi.org/10.3390/tomography10100124
Chicago/Turabian StyleBashir, Zubair, Liqi Shu, Yuqian Guo, Edward W. Chen, Shuyuan Wang, Eric D. Goldstein, Maheen Rana, Narendra Kala, Xing Dai, Daniel Mandel, and et al. 2024. "Left Ventricular Diastolic Dysfunction with Elevated Filling Pressures Is Associated with Embolic Stroke of Undetermined Source and Atrial Fibrillation" Tomography 10, no. 10: 1694-1705. https://doi.org/10.3390/tomography10100124