Abstract 716: Echocardiographic Evidence of Systemic Atherosclerosis and Long-Term Outcomes in Patients with Non-Hemorrhagic Stroke
Background: Echocardiography is routinely performed for evaluation of cardiac embolic causes in patients with non-hemorrhagic stroke. However, added value of echocardiographic evidence for systemic atherosclerosis in patients with known peripheral disease and non-hemorrhagic stroke has not been well established.
Material and Methods: Retrospective chart review was performed in 517 consecutive patients treated for non-hemorrhagic stroke at a single academic medical center. Complete transthoracic echocardiograms were reviewed for presence of mitral annular calcifications, valve sclerosis, or aortic atherosclerosis. Long-term outcomes were ascertained through the National Death Index. This study was approved by the institutional IRB.
Results: The study cohort included 48% females. Coronary artery disease (CAD) was present in 27%, hypertension in 62%, diabetes in 20%, dyslipidemia in 38%, peripheral vascular disease (PVD) in 4%, and end-stage renal disease in 5%. Echocardiographic evidence of systemic atherosclerosis was noted in 43%.
We observed 28% mortality at the mean follow-up length of 46+/-20 months. Mortality was significantly increased in older patients, and in patients with histories of end-stage renal disease (p=0.048), PVD (p<0.001), diabetes (p=0.05), hypertension (p=0.027), and CAD (p=0.012). Echocardiographic evidence of systemic atherosclerosis was associated with a 2-fold increase in mortality (20 vs. 40%, p<0.0001).
In multivariate logistic regression analysis, when adjusted for recorded end-points, the echocardiographic evidence of systemic atherosclerosis was not predictive of adverse outcomes. Only age (HR 1.9, 95%CI 1.6-2.4, p<0.0001), diabetes (HR 1.9, 95% CI 1.1-3.3, p=0.029), and PVD (HR 5.1, 95%CI 1.8-14.4, p=0.0024) were associated with increased mortality.
Conclusions: In patients with non-hemorrhagic stroke, systemic evidence of atherosclerosis suggested by transthoracic echocardiography is not associated with worse long-term prognosis. This should not preclude providers from performing an echocardiographic evaluation if clinically indicated. The question of diagnostic utility for post stroke transthoracic echocardiography is an important topic and warrants further study.
Author Disclosures: J. Pieper: None. M. Ashamalla: None. N. Yager: None. D. Sedhom: None. K. Ghate: None. V. Nguyen: None. B. Shkolnik: None. M. Torosoff: None.
- © 2015 by American Heart Association, Inc.