Supplementary Material for: Diastolic Dysfunction and Outcome in Acute Ischemic Stroke

<b><i>Background:</i></b> Left ventricular diastolic dysfunction (DD) is associated with an increased mortality in general population and patients with myocardial infarct. In the present study, we investigated whether DD is associated with outcomes after ischemic stroke. <b><i>Methods:</i></b> Five hundred and three acute ischemic stroke patients with normal left ventricular ejection fraction (≥50%) were retrospectively included. Echocardiography and tissue Doppler imaging were used to evaluate and grade diastolic function. Ordinal logistic and Cox regression analyses were used to examine relations between DD and modified Rankin Scale (mRS) score at 3 months and mortality after stroke, respectively. <b><i>Results:</i></b> Mean age was 67.2 ± 11.8 years and 63% were men. Among parameters of diastolic function, early mitral inflow velocity/early diastolic mitral annulus velocity (E/e') was independently related with higher mRS score at 3 months and mortality after ischemic stroke. The highest quartile of E/e' (&gt;14) was independently associated with higher mRS score (adjusted OR 3.86, 95% CI 2.27-6.54) as well as with mortality (hazards ratio [HR] 2.87, 95% CI 1.17-7.04) as compared to the lowest quartile of E/e' (&lt;8.8). In addition, moderate-to-severe DD grade was related to higher mRS score (adjusted OR 2.41, 95% CI 1.15-5.06) and mortality (HR 6.63, 95% CI 1.80-24.43) compared to the normal diastolic function. <b><i>Conclusion:</i></b> In patients with ischemic stroke, DD is associated with functional outcome at 3 months and mortality. Our data suggest that more attention should be given to DD in patients with ischemic stroke.

<b><i>背景：</i></b> 左心室舒张功能障碍（Left ventricular diastolic dysfunction, DD）在普通人群及心肌梗死患者中与死亡率升高显著相关。本研究旨在探讨左心室舒张功能障碍是否与缺血性脑卒中后的临床预后存在关联。<b><i>方法：</i></b> 本研究回顾性纳入503例左心室射血分数正常（≥50%）的急性缺血性脑卒中患者。采用超声心动图与组织多普勒成像技术评估并分级患者的左心室舒张功能。分别通过有序logistic回归与Cox回归分析，考察左心室舒张功能障碍与卒中后3个月改良Rankin量表（modified Rankin Scale, mRS）评分及卒中后死亡率的相关性。<b><i>结果：</i></b> 本研究纳入患者的平均年龄为67.2±11.8岁，其中男性占比63%。在舒张功能相关参数中，二尖瓣早期流入速度/二尖瓣环早期舒张速度（E/e'）与卒中后3个月更高的mRS评分及更高的卒中后死亡率独立相关。与E/e'最低四分位数组（<8.8）相比，E/e'最高四分位数组（>14）与更高的mRS评分（校正后比值比[OR]=3.86，95%置信区间[CI]：2.27~6.54）及死亡率（风险比[HR]=2.87，95%CI：1.17~7.04）独立相关。此外，相较于舒张功能正常的患者，中至重度左心室舒张功能障碍分级与更高的mRS评分（校正后OR=2.41，95%CI：1.15~5.06）及死亡率（HR=6.63，95%CI：1.80~24.43）显著相关。<b><i>结论：</i></b> 在缺血性脑卒中患者中，左心室舒张功能障碍与卒中后3个月的功能预后及死亡率显著相关。本研究数据提示，临床工作中应更加重视缺血性脑卒中患者的左心室舒张功能障碍情况。