Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, 5 Boramae-ro, Dongjak-gu, Seoul, 07061, Korea.
Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Korea.
Int J Cardiovasc Imaging. 2020 Aug;36(8):1445-1454. doi: 10.1007/s10554-020-01841-5. Epub 2020 Apr 16.
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.
先前的研究仅关注了 1 或 2 个超声心动图参数作为急性缺血性脑卒中（AIS）患者的预后标志物。回顾性分析了 900 例接受经胸超声心动图检查的 AIS 患者（72.6±12.0 岁，60%为男性）。在临床随访期间评估了复合临床事件，包括全因死亡率、非致死性卒中、非致死性心肌梗死和冠状动脉血运重建。在中位 3.3 年（四分位距 0.6-5.1 年）的随访期间，发生了 151 例（16.8%）复合事件。在调整了潜在混杂因素后的多变量分析中，左心室射血分数（LVEF）<62%（风险比[HR]1.62；95%置信区间[CI]1.14-2.30；p=0.007）和房室瓣（AV）硬化（AVs）（HR 1.56；95%CI 1.10-2.21；p=0.013）是与复合事件相关的独立预后因素。多变量分析显示，根据 LVEF 和 AVs，复合事件的 HR 逐渐增加：最高风险组的 HR 比最低风险组高 2.6 倍（p<0.001）。与临床模型（整体卡方=69.6）相比，LVEF、AVs 以及二者在序贯 Cox 模型分析中均显著改善了预后预测（整体卡方分别为 75.6、75.7 和 78.8；p<0.05）。在 AIS 患者中，LVEF<62%和 AV 硬化的存在可以预测未来的血管事件。表现出 LVEF 降低和 AV 硬化的 AIS 患者可能从强化二级预防中获益。
