Objectives This study sought to investigate the prognostic significance of left ventricular (LV) mass and geometry in ischemic stroke survivors, as well as the LV geometry–specific differences in the blood pressure–mortality relationship.

Background LV mass and geometry are well-known prognostic factors in various populations; however, there are no data on their role in ischemic stroke patients.

Methods We prospectively recruited 2,328 consecutive patients admitted with acute ischemic stroke to our institute between 2002 and 2010. Of these, 2,069 patients were analyzed in whom echocardiographic data were available to assess LV mass and geometry.

Results All-cause mortality was significantly greater in patients with concentric hypertrophy (adjusted hazard ratio [HR]: 1.417; 95% confidence interval [CI]: 1.045 to 1.920) and concentric remodeling (HR: 1.540; 95% CI: 1.115 to 2.127) but nonsignificantly in those with eccentric hypertrophy (HR: 1.388; 95% CI: 0.996 to 1.935) compared with normal geometry in multivariate analyses. Relative wall thickness was a significant predictor of all-cause mortality (HR: 1.149 per 0.1-U increase in relative wall thickness; 95% CI: 1.021 to 1.307), whereas LV mass index was not (HR: 1.003 per 1 g/m² increase in LV mass index; 95% CI: 0.999 to 1.007). Similar results were observed with cardiovascular mortality. In multivariable fractional polynomials, patients with altered LV geometry showed reverse J-curve relationships between acute-phase systolic blood pressure and all-cause or cardiovascular mortality, with the highest risks in the lower extremes, whereas those with normal geometry did not.

Conclusions Echocardiographic assessment of LV geometry provided independent and additive prognostic information in ischemic stroke patients. A reverse J-shaped relation of mortality with blood pressure was found in patients with abnormal LV geometry.

目的本研究旨在探讨缺血性卒中幸存者左心室（LV）的质量和几何形状的预后意义，以及LV几何形状特定的血压与死亡率关系中的差异。

背景LV的质量和几何形状是各种人群中众所周知的预后因素。但是，尚无关于它们在缺血性中风患者中的作用的数据。

方法我们在2002年至2010年间连续招募了2328例急性缺血性卒中患者入选本研究所。在这些患者中，对2069例患者进行了超声心动图检查，以评估其左室质量和几何形状。

结果同心肥大（调整后的危险比[HR]：1.417； 95％置信区间[CI]：1.045至1.920）和同心重塑（HR：1.540； 95％CI：1.115至2.127）的全因死亡率显着更高），但在多变量分析中与正常几何体相比，偏心肥大（HR：1.388; 95％CI：0.996至1.935）的影响不显着。相对壁厚是所有原因死亡率的重要预测指标（HR：相对壁厚每增加0.1-U 1.149； 95％CI：1.021至1.307），而LV质量指数则不然（HR：每1 g / m 1.003）^2个LV质量指数增加；95％CI：0.999至1.007）。心血管死亡率观察到相似的结果。在多变量分数多项式中，LV几何形状改变的患者在急性期收缩压与全因或心血管疾病死亡率之间显示出反向的J曲线关系，在较低的极端情况下风险最高，而那些几何形状正常的患者则没有。

结论超声心动图评估左心室几何形状可为缺血性中风患者提供独立的和附加的预后信息。LV几何异常的患者发现死亡率与血压呈反J形关系。