Author + information
- Received October 21, 2016
- Revision received January 30, 2017
- Accepted February 7, 2017
- Published online March 5, 2018.
- Chan Soon Park, MDa,
- Jun-Bean Park, MD, PhDa,∗ (, )
- Yerim Kim, MDb,
- Yeonyee E. Yoon, MDa,c,
- Seung-Pyo Lee, MD, PhDa,
- Hyung-Kwan Kim, MD, PhDa,
- Yong-Jin Kim, MD, PhDa,
- Goo-Yeong Cho, MD, PhDa,c,
- Dae-Won Sohn, MD, PhDa and
- Seung-Hoon Lee, MD, PhDd,∗∗ ()
- aCardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
- bKangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
- cCardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
- dDepartment of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
- ↵∗Address for correspondence:
Dr. Jun-Bean Park, Cardiovascular Center, Seoul National University Hospital, Room 9623, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea.
- ↵∗∗Dr. Seung-Hoon Lee, Department of Neurology, Seoul National University Hospital, Room 11604, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea.
Objectives This study sought to investigate the prognostic significance of left ventricular (LV) mass and geometry in ischemic stroke survivors, as well as the LV geometry–specific differences in the blood pressure–mortality relationship.
Background LV mass and geometry are well-known prognostic factors in various populations; however, there are no data on their role in ischemic stroke patients.
Methods We prospectively recruited 2,328 consecutive patients admitted with acute ischemic stroke to our institute between 2002 and 2010. Of these, 2,069 patients were analyzed in whom echocardiographic data were available to assess LV mass and geometry.
Results All-cause mortality was significantly greater in patients with concentric hypertrophy (adjusted hazard ratio [HR]: 1.417; 95% confidence interval [CI]: 1.045 to 1.920) and concentric remodeling (HR: 1.540; 95% CI: 1.115 to 2.127) but nonsignificantly in those with eccentric hypertrophy (HR: 1.388; 95% CI: 0.996 to 1.935) compared with normal geometry in multivariate analyses. Relative wall thickness was a significant predictor of all-cause mortality (HR: 1.149 per 0.1-U increase in relative wall thickness; 95% CI: 1.021 to 1.307), whereas LV mass index was not (HR: 1.003 per 1 g/m2 increase in LV mass index; 95% CI: 0.999 to 1.007). Similar results were observed with cardiovascular mortality. In multivariable fractional polynomials, patients with altered LV geometry showed reverse J-curve relationships between acute-phase systolic blood pressure and all-cause or cardiovascular mortality, with the highest risks in the lower extremes, whereas those with normal geometry did not.
Conclusions Echocardiographic assessment of LV geometry provided independent and additive prognostic information in ischemic stroke patients. A reverse J-shaped relation of mortality with blood pressure was found in patients with abnormal LV geometry.
This study was supported by 2 grants from the government of Korea: Basic Science Research Program through the National Research Foundation (NRF-2015R1A2A2A01007770), funded by the Ministry of Science, ICT and Future Planning, and Korean Health Technology Research and Development Project (HI13C1961), funded by the Ministry for Health, Welfare and Family Affairs. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Jun-Bean Park and Seung-Hoon Lee contributed equally to this work.
- Received October 21, 2016.
- Revision received January 30, 2017.
- Accepted February 7, 2017.
- 2018 American College of Cardiology Foundation