Diastolic Dysfunction Linked With Stroke, Transient Ischemic Attack, Major Bleeding

An independent association exists between left ventricular diastolic dysfunction (DD) severity and risk for incident stroke and transient ischemic attack (TIA), as well as major bleeding, according to study findings published in Stroke.

Investigators evaluated the possible association between DD and adverse cardiovascular outcomes, specifically the DD impact on major bleeding and risk for stroke and TIA.

The investigators conducted a retrospective observational cohort analysis using deidentified data collected from the University of Pittsburgh Medical Center Analytics Department, Pittsburgh, Pennsylvania, US, of consecutive patients with an echocardiogram performed between 2010 and 2022 at any of the associated institutional hospitals or clinics, plus at least 3 months follow-up. Presence of DD and DD severity were assessed for an independent association with the risk for major bleeding and cerebrovascular events. Patients with history of major bleeding, TIA, or stroke were among those excluded.

Overall, patients (mean age, 56 [SD, 18] years; 56% women) with DD grade I (n=18,164), grade II (n=5881), and grade III (n=1340) and patients with no DD (n=96,702) were included in the cohort analysis. Those excluded because DD could not be determined due to mitral valve disease, atrial fibrillation, or other conditions were more likely to be older men with significantly higher rates of cardiac and noncardiac comorbidities compared with included patients.

The investigators found that 4.6% of patients were hospitalized for major bleeding and 2.4% for stroke or TIA over a median follow-up of 3.4 years. Each worsening grade of DD was associated with a 68% increase in risk for major bleeding (hazard ratio [HR], 1.68; 95% CI, 1.62-1.73) and an 80% increase in risk for TIA or stroke (HR, 1.80; 95% CI, 1.72-1.88; all P <.001).

After adjusting for use of anticoagulation agents, use of antiplatelet agents, chronic kidney disease, CHA₂DS₂-VASc score, age, history of atrial fibrillation, household income, and year of echocardiographic testing, DD persisted as a strong predictor of major bleeding (HR, 1.20 per grade increase in DD; 95% CI, 1.16-1.25) and incident stroke and TIA (HR, 1.22 per grade increase in DD; 95% CI, 1.16-1.29; all P <.001).

Study limitations include the observational design, confounding of results by undiagnosed atrial fibrillation, and inherent coding errors in administrative data. Additionally, the significant proportion of patients excluded because DD could not be determined (≈26%) limits generalizability.

“DD is independently associated with a higher risk of cerebrovascular accidents and major bleeding,” the investigators concluded. “These findings are independent of a history of atrial fibrillation and have important clinical implications for the counseling and management of patients with echocardiographic evidence of DD…”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on The Cardiology Advisor