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

Abstract

The aim of this study was to identify whether diastolic dysfunction predicts death at 90 days after acute ischemic stroke. Methods: 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. Results: 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; 4 95% CI 0.80-0.85). Conclusions: 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.

Predicting 10-year stroke mortality: development and validation of a nomogram

“…The total of all these scores (Total Point axis) can then be used to determine the predicted 10-year mortality (10-year Mortality axis) been externally validated. Data unavailability and limited resources can be a potential obstacle in wider adoption of these scores, which can be the case with some of the models including biomarkers [44] or those using imaging data [45].…”

“…A review of acute stroke prediction models [ 6 ] such as iSCORE, SOAR, PLAN and THRIVE amongst others, concluded that practical aspects of the score can be potentially a limiting factor in the clinical usage of the scores, as the majority of them have a good predictive accuracy and have been externally validated. Data unavailability and limited resources can be a potential obstacle in wider adoption of these scores, which can be the case with some of the models including biomarkers [ 44 ] or those using imaging data [ 45 ].…”

Effect of Cerebral Ischemic Strokes in Different Cerebral Artery Regions on Left Ventricular Function

“…Thalamic strokes, located in the posterior cerebral artery (PCA) region, can cause disturbance of the autonomic nervous system in Takotsubo cardiomyopathy ( 7 ). The nucleus ambiguous and nucleus dorsalis, located in the basilar artery (BA) region, convey parasympathetic modulation of the central cardiovascular system ( 8 ). In the event of a stroke, the balance between parasympathetic and sympathetic modulation is disrupted, leading to the coronary artery spasm and myocardial ischemia ( 9 ).…”