Skip to main content

Advertisement

SpringerLink
Log in

Diastolic myocardial dysfunction by tissue Doppler imaging predicts mortality in patients with cerebral infarction

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Several clinical prediction score models have been investigated for predicting mortality in patients with cerebral infarction. However, none of these include echocardiographic measures. Our objective was to evaluate the prognostic value of tissue Doppler imaging (TDI) of the myocardium in patients with cerebral infarction. Two hundred forty-four patients with cerebral infarction and subsequent echocardiographic examination in sinus rhythm were identified. Using TDI in three apical projections, longitudinal mitral annular velocities were obtained in six segments. Cox regression models, C-statistics and reclassification analysis were performed for global and segmental e′. During a median follow-up of 3 years 42 patients died. Patients who died had significantly impaired systolic and diastolic function (determined by LVEF and E/e′). The risk of dying increased with decreasing global e′, being approximately 13 times higher for patients in the lowest tertile compared to patients in the highest tertile (HR 13.4 [3.2;56.3], p < 0.001). Patients with significantly impaired global e′ showed increased mortality after multivariable adjustment for: LVEF, E/e′, age, gender, heart failure, chronic obstructive pulmonary disease, prior cerebral infarction, ischemic heart disease, cancer, hypertension, hypercholesterolemia, carotid stenosis, mitral regurgitation, liver disease and thromboembolisms (HR 1.9 [1.1;3.2]), per 1 cm/s decrease, p < 0.05). Similar pattern was seen in segmental analyses of the e′. In contrast to e′, no conventional echocardiographic parameters remained independent predictors of mortality after multivariable adjustment. Diastolic myocardial dysfunction determined as e′ by TDI is a significant predictor of mortality in patients with cerebral infarction. Applying this parameter can aid the prognostic assessment after cerebral infarction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Sacco RL, Wolf PA, Kannel WB, McNamara PM (1982) Survival and recurrence following stroke. The Framingham study. Stroke 13(3):290–295

    Article  CAS  PubMed  Google Scholar 

  2. Schwamm LH, Pancioli A, Acker JE 3rd, Goldstein LB, Zorowitz RD, Shephard TJ et al (2005) Recommendations for the establishment of stroke systems of care: recommendations from the American Stroke Association’s Task Force on the Development of Stroke Systems. Circulation 111(8):1078–1091

    Article  PubMed  Google Scholar 

  3. Adams HP Jr, Davis PH, Leira EC, Chang KC, Bendixen BH, Clarke WR et al (1999) Baseline NIH Stroke Scale score strongly predicts outcome after stroke: a report of the trial of Org 10172 in acute stroke treatment (TOAST). Neurology 53(1):126–131

    Article  CAS  PubMed  Google Scholar 

  4. Ntaios G, Faouzi M, Ferrari J, Lang W, Vemmos K, Michel P (2012) An integer-based score to predict functional outcome in acute ischemic stroke: the ASTRAL score. Neurology 78(24):1916–1922

    Article  CAS  PubMed  Google Scholar 

  5. Saposnik G, Kapral MK, Liu Y, Hall R, O’Donnell M, Raptis S et al (2011) IScore: a risk score to predict death early after hospitalization for an acute ischemic stroke. Circulation 123(7):739–749

    Article  PubMed  Google Scholar 

  6. O’Donnell MJ, Fang J, D’Uva C, Saposnik G, Gould L, McGrath E et al (2012) The PLAN score: a bedside prediction rule for death and severe disability following acute ischemic stroke. Arch Intern Med 172(20):1548–1556

    Article  PubMed  Google Scholar 

  7. Counsell C, Dennis M (2001) Systematic review of prognostic models in patients with acute stroke. Cerebrovasc Dis 12(3):159–170

    Article  CAS  PubMed  Google Scholar 

  8. Kwakkel G, Wagenaar RC, Kollen BJ, Lankhorst GJ (1996) Predicting disability in stroke–a critical review of the literature. Age Ageing 25(6):479–489

    Article  CAS  PubMed  Google Scholar 

  9. Soler EP, Ruiz VC (2010) Epidemiology and risk factors of cerebral ischemia and ischemic heart diseases: similarities and differences. Curr Cardiol Rev 6(3):138–149

    Article  PubMed Central  PubMed  Google Scholar 

  10. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ et al (2014) Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation 129(3):e28–e292

    Article  PubMed  Google Scholar 

  11. Ois A, Gomis M, Cuadrado-Godia E, Jiménez-Conde J, Rodríguez-Campello A, Bruguera J et al (2008) Heart failure in acute ischemic stroke. J Neurol 255(3):385–389

    Article  PubMed  Google Scholar 

  12. Sacco RL, Shi T, Zamanillo MC, Kargman DE (1994) Predictors of mortality and recurrence after hospitalized cerebral infarction in an urban community: the Northern Manhattan Stroke Study. Neurology 44(4):626–634

    Article  CAS  PubMed  Google Scholar 

  13. Milionis H, Faouzi M, Cordier M, D’Ambrogio-Remillard S, Eskandari A, Michel P (2013) Characteristics and early and long-term outcome in patients with acute ischemic stroke and low ejection fraction. Int J Cardiol 168(2):1082–1087

    Article  PubMed  Google Scholar 

  14. Holmström A, Fu MLX, Hjalmarsson C, Bokemark L, Andersson B (2013) Heart dysfunction in patients with acute ischemic stroke or TIA does not predict all-cause mortality at long-term follow-up. BMC Neurol 13:122–129

    Article  PubMed Central  PubMed  Google Scholar 

  15. Ward RP, Don CW, Furlong KT, Lang RM (2006) Predictors of long-term mortality in patients with ischemic stroke referred for transesophageal echocardiography. Stroke 37(1):204–208

    Article  PubMed  Google Scholar 

  16. O’Brien PJ, Thiemann DR, McNamara RL, Roberts JW, Raska K, Oppenheimer SM et al (1998) Usefulness of transesophageal echocardiography in predicting mortality and morbidity in stroke patients without clinically known cardiac sources of embolus. Am J Cardiol 81(9):1144–1151

    Article  PubMed  Google Scholar 

  17. Biering-Sørensen T, Jensen JS, Pedersen S, Galatius S, Hoffmann S, Jensen MT et al (2014) Doppler tissue imaging is an independent predictor of outcome in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. J Am Soc Echocardiogr 27(3):258–267

    Article  PubMed  Google Scholar 

  18. Biering-Sørensen T, Mogelvang R, Pedersen S, Schnohr P, Sogaard P, Jensen JS (2011) Usefulness of the myocardial performance index determined by tissue Doppler imaging m-mode for predicting mortality in the general population. Am J Cardiol 107(3):478–483

    Article  PubMed  Google Scholar 

  19. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA et al (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18(12):1440–1463

    Article  PubMed  Google Scholar 

  20. De Knegt MC, Biering-Sorensen T, Sogaard P, Sivertsen J, Jensen JS, Mogelvang R (2014) Concordance and reproducibility between M-mode, tissue Doppler imaging, and two-dimensional strain imaging in the assessment of mitral annular displacement and velocity in patients with various heart conditions. Eur Heart J Cardiovasc Imaging 15(1):62–69

    Article  PubMed  Google Scholar 

  21. Pepi M, Evangelista A, Nihoyannopoulos P, Flachskampf FA, Athanassopoulos G, Colonna P et al (2010) Recommendations for echocardiography use in the diagnosis and management of cardiac sources of embolism: European Association of Echocardiography (EAE) (a registered branch of the ESC). Eur J Echocardiogr 11(6):461–476

    Article  PubMed  Google Scholar 

  22. de Abreu TT, Mateus S, Correia J (2005) Therapy implications of transthoracic echocardiography in acute ischemic stroke patients. Stroke 36(7):1565–1566

    Article  PubMed  Google Scholar 

  23. Douen A, Pageau N, Medic S (2007) Usefulness of cardiovascular investigations in stroke management: clinical relevance and economic implications. Stroke 38(6):1956–1958

    Article  PubMed  Google Scholar 

  24. McNamara RL, Lima JA, Whelton PK, Powe NR (1997) Echocardiographic identification of cardiovascular sources of emboli to guide clinical management of stroke: a cost-effectiveness analysis. Ann Intern Med 127(9):775–787

    Article  CAS  PubMed  Google Scholar 

  25. Azemi T, Rabdiya VM, Ayirala SR, McCullough LD, Silverman DI (2012) Left atrial strain is reduced in patients with atrial fibrillation, stroke or TIA, and low risk CHADS(2) scores. J Am Soc Echocardiogr 25(12):1327–1332

    Article  PubMed  Google Scholar 

  26. Karabay CY, Zehir R, Güler A, Oduncu V, Kalayci A, Aung SM et al (2013) Left atrial deformation parameters predict left atrial appendage function and thrombus in patients in sinus rhythm with suspected cardioembolic stroke: a speckle tracking and transesophageal echocardiography study. Echocardiography 30(5):572–581

    Article  PubMed  Google Scholar 

  27. Mogelvang R, Sogaard P, Pedersen SA, Olsen NT, Marott JL, Schnohr P et al (2009) Cardiac dysfunction assessed by echocardiographic tissue Doppler imaging is an independent predictor of mortality in the general population. Circulation 119(20):2679–2685

    Article  PubMed  Google Scholar 

  28. Hachinski VC, Smith KE, Silver MD, Gibson CJ, Ciriello J (1986) Acute myocardial and plasma catecholamine changes in experimental stroke. Stroke 17(3):387–390

    Article  CAS  PubMed  Google Scholar 

  29. Myers MG, Norris JW, Hachinski VC, Weingert ME, Sole MJ (1982) Cardiac sequelae of acute stroke. Stroke 13(6):838–842

    Article  CAS  PubMed  Google Scholar 

  30. Samuels MA (2007) «Voodoo » death revisited: the modern lessons of neurocardiology. Cleve Clin J Med 74(Suppl 1):S8–S16

    Article  PubMed  Google Scholar 

  31. Korpelainen JT, Sotaniemi KA, Suominen K, Tolonen U, Myllylä VV (1994) Cardiovascular autonomic reflexes in brain infarction. Stroke 25(4):787–792

    Article  CAS  PubMed  Google Scholar 

  32. Laowattana S, Zeger SL, Lima JAC, Goodman SN, Wittstein IS, Oppenheimer SM (2006) Left insular stroke is associated with adverse cardiac outcome. Neurology 66(4):477–483

    Article  CAS  PubMed  Google Scholar 

  33. Roquer J, Ois A, Rodríguez-Campello A, Gomis M, Munteis E, Jiménez-Conde J et al (2007) Atherosclerotic burden and early mortality in acute ischemic stroke. Arch Neurol 64(5):699–704

    Article  PubMed  Google Scholar 

  34. Zile MR, Brutsaert DL (2002) New concepts in diastolic dysfunction and diastolic heart failure: part II: causal mechanisms and treatment. Circulation 105(12):1503–1508

    Article  PubMed  Google Scholar 

  35. Baltabaeva A, Marciniak M, Bijnens B, Moggridge J, He FJ, Antonios TF et al (2008) Regional left ventricular deformation and geometry analysis provides insights in myocardial remodelling in mild to moderate hypertension. Eur J Echocardiogr 9(4):501–508

    PubMed  Google Scholar 

  36. Cikes M, Sutherland GR, Anderson LJ, Bijnens BH (2010) The role of echocardiographic deformation imaging in hypertrophic myopathies. Nat Rev Cardiol 7(7):384–396

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, P.835, 2900, Hellerup, Denmark

    Flemming J. Olsen, Peter G. Jørgensen, Rasmus Møgelvang, Jan S. Jensen, Thomas Fritz-Hansen, Jan Bech, Jacob Sivertsen & Tor Biering-Sørensen

  2. Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Peter G. Jørgensen, Jan S. Jensen & Tor Biering-Sørensen

Authors
  1. Flemming J. Olsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter G. Jørgensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rasmus Møgelvang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jan S. Jensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas Fritz-Hansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jan Bech
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jacob Sivertsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tor Biering-Sørensen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Flemming J. Olsen.

Ethics declarations

Conflict of interest

No potential conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Olsen, F.J., Jørgensen, P.G., Møgelvang, R. et al. Diastolic myocardial dysfunction by tissue Doppler imaging predicts mortality in patients with cerebral infarction. Int J Cardiovasc Imaging 31, 1413–1422 (2015). https://doi.org/10.1007/s10554-015-0712-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-015-0712-0

Keywords

Search

Navigation