Tissue Doppler index, E/E', and ischemic stroke in patients with atrial fibrillation and preserved left ventricular ejection fraction

Sang Hak Lee, Seonghoon Choi, Wook Jin Chung, Young Sup Byun, Sung Kee Ryu, Wook Bum Pyun, Se Joong Rim

Research output: Contribution to journalArticlepeer-review

46 Scopus citations


Background: Although several risk factors for stroke have been reported in patients with atrial fibrillation (AF), the relation of LV diastolic dysfunction to stroke is still uncertain in these patients. We evaluated the relationship between tissue Doppler-derived index, E/E', as well as other clinical and echocardiographic parameters and ischemic stroke by this cross-sectional study. Methods: Three hundred thirty patients with persistent AF who had preserved LV ejection fraction were included from 6 centers. Clinical data were obtained and standard transthoracic echocardiography was performed. Patients without a history of ischemic stroke (n = 280) were compared with patients with this complication (n = 50). Potential determinants of ischemic stroke were identified by logistic regression analyses. Results: In univariate analyses, age, history of hypertension, diabetes mellitus, hyperlipidemia and symptomatic heart failure, plasma brain natriuretic peptide (BNP) level, early mitral inflow velocity (E), diastolic mitral annular velocity (E'), and E/E' ratio were significantly correlated to ischemic stroke. Multivariate regression analyses identified two significant variables that were independently associated with ischemic stroke: hypertension (odds ratio = 6.03, p = 0.008), and E/E' (odds ratio = 1.21, p = 0.002). Conclusions: These findings may have clinical implications that LV diastolic dysfunction, reflected by E/E', is a significant determinant of ischemic stroke in AF. A larger prospective data is needed to confirm the value of E/E' in risk stratification for ischemic stroke in this population.

Original languageEnglish
Pages (from-to)148-152
Number of pages5
JournalJournal of the Neurological Sciences
Issue number1-2
StatePublished - 15 Aug 2008


  • Atrial fibrillation
  • Cerebrovascular accident
  • Diastole
  • Doppler echocardiography
  • Echocardiography
  • Heart failure
  • Ventricular function


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