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PLoS One. 2014 Apr 23;9(4):e95277. doi: 10.1371/journal.pone.0095277. eCollection 2014.

Cardiac function and outcome in patients with cardio-embolic stroke.

Author information

1
Department of Neurology, Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.
2
Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
3
Department of Neurology, ChungAng university hospital, Seoul, Korea.
4
Department of Neurology, Armed Forces Capital Hospital, Seongnam, Gyeunggido, South Korea.

Abstract

BACKGROUND:

The relationship between whole spectrum of Ejection fraction (EF) and cardioembolic stroke (CES) outcome has not been fully described yet. Notably, it remains unclear whether borderline EF (41∼49%) is related with poor outcome after CES. We sought to evaluate whether lower ejection fraction and borderline EF could predict the outcome in patients with CES.

METHOD AND RESULTS:

We evaluated the relationship between EF and functional outcome in 437 consecutive patients with CES. EF was introduced as continuous and categorical (EF≤40%, EF 41∼49%, EF≥50%) variable. Patients with CES and the subgroup with AF were evaluated separately. Poor short-term outcome (modified Rankin Score≥3at discharge or death within 90 days after stroke onset) and long-term mortality were evaluated. A total of 165 patients (37.8%) had poor short-term outcomes. EF tends to be lower in patients with poor short-term outcome (56.8±11.0 vs. 54.8±12.0, p-value 0.086). Overall cumulative death was136 (31.1%) in all CES patients and 106 (31.7%) in the AF subgroup. In a multivariable model adjusted for possible covariates, the hazard ratio for mortality significantly decreased by 3% for every 1% increase in ejection fraction in CES patients and 2% for every 1% increase in the AF subgroup. Reduced EF (EF≤40%) showed higher mortality (HR 2.61), and those with borderline EF (41∼49%) had a tendency of higher mortality (HR 1.65, p-value 0.067)compared with those with normal EF.

CONCLUSION:

We found a strong association between lower EF and CES outcome. Echocardiographic evaluation helps to better determine the prognosis in CES patients, even in subgroup of patients with AF.

PMID:
24760037
PMCID:
PMC3997393
DOI:
10.1371/journal.pone.0095277
[Indexed for MEDLINE]
Free PMC Article
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