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Sleep-disordered breathing assessed by holter-monitoring is associated to worsened one-year clinical outcomes in ischemic stroke patients: a cardiopulmonary coupling analysis

Session Stroke - The heart brain axis

Speaker Dong Oh Kang

Event : ESC Congress 2019

  • Topic : diseases of the aorta, peripheral vascular disease, stroke
  • Sub-topic : Epidemiology, Prognosis, Outcome
  • Session type : Moderated Posters

Authors : DO Kang (Seoul,KR), CK Kim (Seoul,KR), Y Park (Seoul,KR), WY Jang (Seoul,KR), W Kim (Seoul,KR), JY Choi (Seoul,KR), CU Choi (Seoul,KR), JO Na (Seoul,KR)

D.O. Kang1 , C.K. Kim2 , Y. Park1 , W.Y. Jang1 , W. Kim1 , J.Y. Choi1 , C.U. Choi1 , J.O. Na1 , 1Korea University Guro Hospital, Cardiovascular Center, Division of Cardiology, Department of Internal Medicine - Seoul - Korea (Republic of) , 2Korea University Guro Hospital, Department of Neurology - Seoul - Korea (Republic of) ,

Stroke – Epidemiology, Prognosis, Outcome

European Heart Journal ( 2019 ) 40 ( Supplement ), 3612

Background: Sleep-disorder breathing (SDB) using polysomnography is closely associated to poor functional and clinical outcomes in ischemic stroke patients. The cardiopulmonary coupling analysis using Holter-monitoring (CPC-Holter analysis) is an emerging feasible modality to investigate SDB.

Purpose: We investigated the association between SDB defined by CPC-Holter analysis and one-year clinical outcome in patients with acute ischemic stroke.

Methods: Total 666 patients with acute ischemic stroke who underwent Holter-monitoring were enrolled. The CPC-Holter analysis was conducted and SDB was defined as the presence of narrow-band (NB) coupling during sleep time. Primary outcome was recurrent ischemic stroke, and secondary outcome was major adverse cerebrovascular event (MACE), a composite of recurrent ischemic stroke, transient ischemic attack, and all-cause mortality within one year since discharge.

Result: The NB coupling was present in 205 (30.8%) of 666 patients with mean age of 64.1±12.8 years. The NB group showed significantly higher incidence of both recurrent ischemic stroke (8.3% vs. 1.4%, p<0.001) and MACE (14.9% vs. 3.0%, p<0.001) within one-year. In multivariate analysis, presence of NB coupling remained as an independent predictor of both recurrent ischemic stroke and MACE (HR: 4.81; 95% CI: 1.73–13.4; p=0.003; and HR 4.17; 95% CI: 1.74–10.0; p<0.001, respectively). The results were consistent after propensity-score matched analysis with 164 patient pairs (C-statistics=0.757).

Conclusion: SDB assessed by CPC-Holter analysis at early phase of ischemic stroke is a powerful prognostic marker for predicting one-year adverse clinical outcomes. The CPC analysis using Holter-monitoring is a useful modality and could be easily applied to predict clinical outcomes in acute ischemic stroke patients.

One-year clinical outcomes
Overall population (n=666)PSM population (n=328)
no NB (=461)NB (n=205)Log-rank p-valueOR (95% CI)no NB (n=164)NB (n=164)Log-rank p-valueOR (95% CI)
Recurrent ischemic stroke6 (1.4)14 (8.3)<0.0015.73 (2.20–14.9)3 (2.0)11 (8.1)0.0263.85 (1.07–13.8)
Transient ischemic attack3 (0.7)3 (1.7)0.2752 (1.3)3 (2.1)0.633
Hemorrhagic stroke0 (0.0)2 (1.2)0.0270 (0.0)2 (1.5)0.148
Total death3 (0.7)9 (4.8)0.0012 (1.3)3 (1.9)0.641
MACEs12 (3.0)25 (14.9)<0.0014.63 (2.06–10.4)7 (5.2)17 (13.1)0.0302.95 (1.06–8.21)
Data are expressed as n (%). CI = confidence interval; MACE = major adverse cardiovascular event; NB = narrow-band; OR = odds ratio.
One-year clinical outcomes

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