A score using left ventricular diastolic dysfunction to predict 90-day mortality in acute ischemic stroke: The DONE score

• Published in: Journal of the neurological sciences 2019-03, Vol.398, p.157-162
• Main Authors: Tateishi, Yohei, Kanamoto, Tadashi, Nakaoka, Kenjiro, Yoshimura, Shunsuke, Miyazaki, Teiichiro, Shiraishi, Hirokazu, Morimoto, Shimpei, Tsuneto, Akira, Maemura, Koji, Morofuji, Yoichi, Horie, Nobutaka, Izumo, Tsuyoshi, Tsujino, Akira
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Brain Ischemia - diagnostic imaging; Brain Ischemia - mortality; Brain Ischemia - physiopathology; Cohort Studies; Diastolic dysfunction; Echocardiography - methods; Female; Humans; Ischemic stroke; Male; Mortality; Mortality - trends; Predictive Value of Tests; Prospective Studies; Retrospective Studies; Stroke - diagnostic imaging; Stroke - mortality; Stroke - physiopathology; Time Factors; Transthoracic echocardiography; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - mortality; Ventricular Dysfunction, Left - physiopathology
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2019.01.021

The aim of this study was to identify whether diastolic dysfunction predicts death at 90 days after acute ischemic stroke. We retrospectively analyzed patients with ischemic stroke. All patients underwent transthoracic echocardiography to evaluate systolic function and diastolic function by means of assessing ejection fraction and septal E/e'. We evaluated the initial National Institute of Health Stroke Scale (NIHSS) score, arterial occlusion, and laboratory data. We used multivariate regression models to identify independent predictors of 90-day mortality. Among 1208 patients, the overall 90-day mortality rate was 8%. In multivariate logistic regression analysis, a higher initial NIHSS score, plasma D-dimer level and E/e', and occlusion of internal carotid artery or basilar artery were independent predictors of 90-day mortality. The DONE score derived from these valuables showed good discrimination with area under the curve (AUC) value of 0.82 (95% confidence interval [CI], 0.78–0.87) to predict 90-day mortality. The DONE score also predicted poor outcome (modified Rankin scale score, 4–6) at 90 days (AUC, 0.82; 95% CI 0.80–0.85). Higher E/e', indicating diastolic dysfunction, may be associated with 90-day mortality in patients with acute ischemic stroke. The DONE score could readily predict poor outcome after acute ischemic stroke. •Elevated E/e' could predict 90-day mortality in patients with ischemic stroke.•We developed a clinical score, the DONE score, for prediction of 90-day mortality.•The DONE score was consisted of D-dimer, Occlusion of ICA or BA, NIHSS score and E/e'.•The mortality was about 30% in patients with the DONE score ≧64.•The DONE score also could predict poor outcome at 90 days.