Association Between Left Ventricular Ejection Fraction, Wall Motion Abnormality, and Embolic Stroke of Undetermined Source
Open Access
- 7 May 2019
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American Heart Association
- Vol. 8 (9), e011593
- https://doi.org/10.1161/jaha.118.011593
Abstract
Background It is uncertain whether there is an association between left ventricular (LV) ejection fraction (LVEF) or LV wall motion abnormality and embolic stroke of undetermined source (ESUS). Methods and Results We performed a retrospective, cross‐sectional study of patients with acute ischemic stroke enrolled in the CAESAR (Cornell Acute Stroke Academic Registry) from 2011 to 2016. We restricted this study to patients with ESUS and, as controls, those with small‐ and large‐artery ischemic strokes. LVEF had to be above 35% to be considered ESUS. In a secondary analysis, we excluded patients with ESUS who had any evidence of ipsilateral carotid atherosclerosis. Multiple logistic regression was used to evaluate whether LVEF or LV wall motion abnormality was associated with ESUS. We performed a confirmatory study at another tertiary‐care center. We identified 885 patients with ESUS (n=503) or small‐ or large‐artery strokes (n=382). Among the entire cohort, LVEF was not associated with ESUS (odds ratio per 5% decrement in LVEF, 1.0; 95% CI, 1.0–1.1) and LV wall motion abnormality was not associated with ESUS (odds ratio, 0.9; 95% CI, 0.5–1.6). The results were identical in our confirmatory study. In our secondary analysis excluding ESUS patients with any evidence of ipsilateral carotid atherosclerosis, there was an association between LVEF and ESUS (odds ratio per 5% decrement in LVEF, 1.2; 95% CI, 1.0–1.5; P=0.04). Conclusions Among the entire cohort, no association existed between LVEF or LV wall motion abnormality and ESUS; however, after excluding ESUS patients with any evidence of ipsilateral carotid atherosclerosis, lower LVEF appeared to be associated with ESUS.This publication has 18 references indexed in Scilit:
- Atrial Cardiopathy and Cryptogenic Stroke: A Cross-sectional Pilot StudyJournal of Stroke and Cerebrovascular Diseases, 2015
- Incidence, outcome, risk factors, and long-term prognosis of cryptogenic transient ischaemic attack and ischaemic stroke: a population-based studyThe Lancet Neurology, 2015
- Embolic strokes of undetermined source: the case for a new clinical constructThe Lancet Neurology, 2014
- Prevalence and Prognostic Significance of Wall-Motion Abnormalities in Adults Without Clinically Recognized Cardiovascular DiseaseCirculation, 2007
- Left Ventricular Systolic Dysfunction and the Risk of Ischemic Stroke in a Multiethnic PopulationStroke, 2006
- An evidence‐based causative classification system for acute ischemic strokeAnnals of Neurology, 2005
- Cardioembolic stroke: an updateThe Lancet Neurology, 2003
- Persistent activation of coagulation mechanism in unstable angina and myocardial infarction.Circulation, 1994
- Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment.Stroke, 1993
- Infarcts of undetermined cause: The NINCDS stroke data bankAnnals of Neurology, 1989