Left Ventricular Geometry Determines Prognosis and Reverse J-Shaped Relation Between Blood Pressure and Mortality in Ischemic Stroke Patients

• Published in: JACC. Cardiovascular imaging Vol. 11; no. 3; pp. 373 - 382
• Main Authors: Park, Chan Soon, MD, Park, Jun-Bean, MD, PhD, Kim, Yerim, MD, Yoon, Yeonyee E., MD, Lee, Seung-Pyo, MD, PhD, Kim, Hyung-Kwan, MD, PhD, Kim, Yong-Jin, MD, PhD, Cho, Goo-Yeong, MD, PhD, Sohn, Dae-Won, MD, PhD, Lee, Seung-Hoon, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2018
• Subjects: acute ischemic stroke; blood pressure; Cardiovascular; left ventricular geometry; left ventricular mass; mortality; NIHSS; blood pressure; left ventricular geometry; LVMi; CBF; LV; area under the curve; left ventricular mass index; left ventricular mass; BP; RWT; AUC; acute ischemic stroke; mortality; cerebral blood flow; National Institutes of Health Stroke Scale; left ventricular; relative wall thickness; blood pressure; left ventricular mass
• ISSN: 1936-878X; 1876-7591
• DOI: 10.1016/j.jcmg.2017.02.015

Abstract 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.