Jeonggeun Moon1, Hye-Jeong Lee2, Young Jin Kim2, Jong-Youn Kim3, Hui-Nam Pak3, Jong-Won Ha3, Moon-Hyoung Lee3, Boyoung Joung4. 1. Cardiology Division, Department of Internal Medicine, Gachon University of Medicine and Science, Incheon, Republic of Korea; Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea. 2. Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea. 3. Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea. 4. Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: cby6908@yuhs.ac.
Abstract
BACKGROUND: For decades, repeated epidemiologic observations have been made regarding the inverse relationship between stature and cardiovascular disease, including stroke. However, the concept has not been fully evaluated in patients with atrial fibrillation (AF). We investigated whether patient's height is associated with ischemic stroke in patients with nonvalvular AF and attempted to ascertain a potential mechanism. METHODS: All 558 AF patients were enrolled: 211 patients with ischemic stroke (144 men, 68 ± 10 years) and 347 no-stroke patients (275 men, 56 ± 11 years) as a control group. Clinical characteristics and echocardiographic parameters were compared between the two groups. RESULTS: (1) Stroke patients were shorter than those in the control group (164 ± 8, vs. 169 ± 8 cm, p<0.001). However, body mass index failed to predict ischemic stroke; (2) Short stature (OR 0.93, 95% CI 0.91-0.95, p<0.001) along with left atrial (LA) anterior-posterior diameter and diastolic mitral inflow velocity (E) to diastolic mitral annuls velocity (E') (E/E') were independent predictor of stroke; (3) Height showed inverse correlation with E/E' independently, even after adjusting for other variables, including age, sex, and body weight, and comorbidities β -0.20, p=0.003); (4) LA size showed no correlation with stature (R=-0.06, p=0.18), whereas left ventricular size increases according to height of patients. CONCLUSIONS: Short stature is associated with occurrence of ischemic stroke and diastolic dysfunction in patients with AF and preserved systolic function. Height is a non-modifiable risk factor of stroke and might be more important than obesity in Asian AF patients, who are relatively thinner than western populations.
BACKGROUND: For decades, repeated epidemiologic observations have been made regarding the inverse relationship between stature and cardiovascular disease, including stroke. However, the concept has not been fully evaluated in patients with atrial fibrillation (AF). We investigated whether patient's height is associated with ischemic stroke in patients with nonvalvular AF and attempted to ascertain a potential mechanism. METHODS: All 558 AFpatients were enrolled: 211 patients with ischemic stroke (144 men, 68 ± 10 years) and 347 no-strokepatients (275 men, 56 ± 11 years) as a control group. Clinical characteristics and echocardiographic parameters were compared between the two groups. RESULTS: (1) Strokepatients were shorter than those in the control group (164 ± 8, vs. 169 ± 8 cm, p<0.001). However, body mass index failed to predict ischemic stroke; (2) Short stature (OR 0.93, 95% CI 0.91-0.95, p<0.001) along with left atrial (LA) anterior-posterior diameter and diastolic mitral inflow velocity (E) to diastolic mitral annuls velocity (E') (E/E') were independent predictor of stroke; (3) Height showed inverse correlation with E/E' independently, even after adjusting for other variables, including age, sex, and body weight, and comorbidities β -0.20, p=0.003); (4) LA size showed no correlation with stature (R=-0.06, p=0.18), whereas left ventricular size increases according to height of patients. CONCLUSIONS: Short stature is associated with occurrence of ischemic stroke and diastolic dysfunction in patients with AF and preserved systolic function. Height is a non-modifiable risk factor of stroke and might be more important than obesity in Asian AFpatients, who are relatively thinner than western populations.