Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Oct;15(4):545-554.
doi: 10.3988/jcn.2019.15.4.545.

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

Jin Man Jung  1 , Yong Hyun Kim  2 , Sungwook Yu  3 , Kyungmi O  3 , Chi Kyung Kim  4 , Tae Jin Song  5 , Yong Jae Kim  6 , Bum Joon Kim  7 , Sung Hyuk Heo  7 , Kwang Yeol Park  8 , Jeong Min Kim  8 , Jong Ho Park  9 , Jay Chol Choi  10 , Man Seok Park  11 , Joon Tae Kim  11 , Kang Ho Choi  11   12 , Yang Ha Hwang  13 , Jong Won Chung  14 , Oh Young Bang  14 , Gyeong Moon Kim  14 , Woo Keun Seo  15
Affiliations

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

Jin Man Jung et al. J Clin Neurol. 2019 Oct.

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.

Keywords: atrial fibrillation; echocardiography; outcomes; stroke.

PubMed Disclaimer

Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Flow chart of included patients. TIA: transient ischemic attack, TTE: transthoracic echocardiography.
Fig. 2
Fig. 2. Survival curves of recurrent stroke (A), major adverse cardiac events (B), and all-cause death (C). LVEF: left-ventricle ejection fraction.
Fig. 3
Fig. 3. Multivariable fractional polynomial plots. The x-axis shows the HR and the y-axis is the LVEF (%). A: Recurrent stroke. B: Major adverse cardiac events. C: All-cause death. HR: hazard ratio, LVEF: left-ventricle ejection fraction.
Fig. 4
Fig. 4. Results from subgroup analyses of all-cause death (A) and major adverse cardiac events (B). AF: atrial fibrillation, BMI: body mass index, E: peak transmitral filling velocity, e′: mean mitral annular velocity at early diastole, IA: intra-arterial, iLAD: indexed left atrium diameter, IV: intravenous, mRS: modified Rankin Scale, NIHSS: National Institutes of Health Stroke Scale.
See this image and copyright information in PMC

References

    1. Guo XY, Li N, Du X, Bai R, Yu RH, Long DY, et al. Atrial fibrillation is associated with an increased risk of myocardial infarction: insights from a meta-analysis. Atherosclerosis. 2016;254:1–7. - PubMed
    1. Kaarisalo MM, Immonen-Räihä P, Marttila RJ, Salomaa V, Kaarsalo E, Salmi K, et al. Atrial fibrillation and stroke. Mortality and causes of death after the first acute ischemic stroke. Stroke. 1997;28:311–315. - PubMed
    1. Marini C, De Santis F, Sacco S, Russo T, Olivieri L, Totaro R, et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a population-based study. Stroke. 2005;36:1115–1119. - PubMed
    1. Lin HJ, Wolf PA, Kelly-Hayes M, Beiser AS, Kase CS, Benjamin EJ, et al. Stroke severity in atrial fibrillation. The Framingham Study. Stroke. 1996;27:1760–1764. - PubMed
    1. Koga M, Yoshimura S, Hasegawa Y, Shibuya S, Ito Y, Matsuoka H, et al. Higher risk of ischemic events in secondary prevention for patients with persistent than those with paroxysmal atrial fibrillation. Stroke. 2016;47:2582–2588. - PubMed