IMR Press / RCM / Volume 23 / Issue 1 / DOI: 10.31083/j.rcm2301010
Open Access Original Research
Impact of aortic atheroma and distensibility on diastolic function and prognosis in patients with ischemic stroke
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1 Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 03722 Seoul, Republic of Korea
2 Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, 06273 Seoul, Republic of Korea
3 Department of Neurology, Gangnam Severance Hospital, 06273 Seoul, Republic of Korea
*Correspondence: choi0928@yuhs.ac (Eui-Young Choi)
Academic Editors: Brian Tomlinson and Takatoshi Kasai
Rev. Cardiovasc. Med. 2022, 23(1), 10; https://doi.org/10.31083/j.rcm2301010
Submitted: 25 October 2021 | Revised: 30 November 2021 | Accepted: 7 December 2021 | Published: 11 January 2022
(This article belongs to the Special Issue State-of-the-Art Cardiovascular Medicine in Asia 2021)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Background: Patients with ischemic stroke are vulnerable to heart failure with preserved ejection fraction (HFpEF) because these conditions share common risk factors. Although evaluation of the ascending aorta, aortic arch, and proximal descending thoracic aorta is an essential step to determine the source of the causative embolism, the relationship between the degree of aortic atheroma and left ventricular (LV) diastolic function has not been extensively investigated. Methods: We analyzed the transesophageal and transthoracic echocardiography in ischemic stroke patients. Patients with previous coronary artery disease, valvular heart disease of more than moderate degree, and an LV ejection fraction of less than 50% were excluded. The relationships between the grade of the aortic atheroma, aortic stiffness indexes, and diastolic functional indexes were evaluated. Results: In 295 patients, the atheroma grade was significantly correlated with aortic stiffness index, ratio of mitral annular and inflow velocities (E/e’), left atrial volume index, and LV diastolic elastance. With further adjustment for age, hypertension, diabetes, estimated glomerular filtration rate, left atrial volume index, and LV mass index, the significance of the atheroma grade was attenuated. In the subgroup analysis, the atheroma grade was significantly and independently related to E/e’ in women (β = 0.181, p = 0.032), but not in men. However, atheroma grade was not associated with poor clinical outcomes in either sex. Conclusions: Aortic atheroma grade was significantly and independently related to LV diastolic function, especially in women. This suggests that aortic atheroma is an index of arterial stiffness and a potential risk factor for HFpEF through ventricular-vascular interactions, especially in women.

Keywords
Ischemic stroke
Aortic atheroma
Diastolic function
Prognosis
Figures
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