Work

P4365Heart failure with preserved ejection fraction is associated with cardioembolic stroke independent of history of atrial fibrillation

Year: 2017

Type: article

Abstract: Background: It has been hypothesized that Diastolic Dysfunction (DD) may be associated with a thrombotic milieu even in the absence of AF. However, presently Heart failure with preserved ejection fraction (HFpEF) is not considered a risk factor that merits anticoagulation on its own without the presence of systolic dysfunction. Purpose: We sought to determine if HFpEF is associated with cardioembolic stroke independent of atrial fibrillation. Methods: Patients diagnosed with cardioembolic stroke to our center between June 2008 and May 2014 undergoing transthoracic echocardiogram (TTE) were identified from our registry. Those with inpatient strokes and significant systolic dysfunction (EF<50%) were excluded from retrospective cohort review. Multivariate logistic regression was performed to investigate the association between stroke and diastolic dysfunction, while adjusting for age, race, sex, and history of congestive heart failure, hypertension, diabetes, prior stroke, left atrial enlargement, and atrial fibrillation. Results: 414 patients presenting with acute cardioembolic stroke met inclusion criteria for this investigation. 240 (45.2%) patients demonstrated significant diastolic dysfunction (grade >1). No significant difference in CHADS2 score was noted amongst patients with significant diastolic dysfunction and those without (1.8 vs 1.9, p=0.114). However spontaneous echo contract was found to be more common with DD>1 (p=0.001) On multivariable regression analysis, significant diastolic dysfunction was found to be associated with significantly elevated risk of cardioembolic stroke, independent of AF, age, race, CHF, HTN, DM, or history of stroke (OR 2.00, 95% CI 1.20–3.32, p=0.008).

Source: European Heart Journal

DOI: 10.1093/eurheartj/ehx504.p4365