{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T02:00:31Z","timestamp":1787191231270,"version":"build-2736575974"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Left ventricular diastolic dysfunction (DD) is associated with adverse cardiovascular outcomes including atrial fibrillation. Whether DD is independently associated with incident stroke and transient ischemic attack (TIA) and with bleeding events is not known. We performed this observational cohort analysis to examine the impact of DD on the risk of stroke\/TIA and major bleeding.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>\n              Patients who underwent at least 1 cardiac echocardiogram and were followed for at least 3 months were included in this study. Patients with a prior history of stroke, TIA, or major bleeding, as determined by\n              <jats:italic toggle=\"yes\">International Classifications of Diseases<\/jats:italic>\n              codes, were excluded. Smart key-phrase search was applied to echocardiographic reports to classify patients into 4 groups based on the most severe DD assessment. Patients in whom the presence of DD could not be determined were excluded. The final study cohort was followed to the end point of hospital admission for stroke\/TIA and major bleeding, and independent predictors of these events were evaluated using the multivariable Cox proportional hazards method.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              The final study cohort (age, 56\u00b118 years; 56% women) had 96\u2005702 patients with no DD and 18\u2005164, 5881, and 1340 patients with DD grades I, II, and III, respectively. Over a median follow-up of 3.4 years, 2938 (2.4%) patients were hospitalized for stroke\/TIA and 5567 (4.6%) for major bleeding. After adjusting for age, the CHA\n              <jats:sub>2<\/jats:sub>\n              DS\n              <jats:sub>2<\/jats:sub>\n              -VASc score, chronic kidney disease, use of antiplatelet agents, use of anticoagulation agents, the year of echocardiographic testing, household income, and history of atrial fibrillation, DD remained a strong predictor of incident stroke\/TIA (hazard ratio, 1.22 per grade increase in DD [95% CI, 1.16\u20131.29];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.001) and major bleeding (hazard ratio, 1.20 per grade increase in DD [95% CI, 1.16\u20131.25];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.001).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>DD is independently associated with a higher risk of cerebrovascular accidents and major bleeding. DD should be considered when counseling patients regarding their risk profile and management options.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.124.048287","type":"journal-article","created":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T10:00:32Z","timestamp":1731319232000},"page":"2856-2862","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Diastolic Dysfunction and the Risk of Stroke and Major Bleeding"],"prefix":"10.1161","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8076-279X","authenticated-orcid":true,"given":"John","family":"Kundrick","sequence":"first","affiliation":[{"name":"Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karina I.","family":"Saba","sequence":"additional","affiliation":[{"name":"Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0880-405X","authenticated-orcid":true,"given":"Aditi","family":"Naniwadekar","sequence":"additional","affiliation":[{"name":"Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia","family":"Singla","sequence":"additional","affiliation":[{"name":"Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5060-429X","authenticated-orcid":true,"given":"Suresh","family":"Mulukutla","sequence":"additional","affiliation":[{"name":"Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Floyd","family":"Thoma","sequence":"additional","affiliation":[{"name":"Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7827-5977","authenticated-orcid":true,"given":"Aditya","family":"Bhonsale","sequence":"additional","affiliation":[{"name":"Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2550-9359","authenticated-orcid":true,"given":"Krishna","family":"Kancharla","sequence":"additional","affiliation":[{"name":"Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1577-6541","authenticated-orcid":true,"given":"Andrew","family":"Voigt","sequence":"additional","affiliation":[{"name":"Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2000-7678","authenticated-orcid":true,"given":"Alaa A.","family":"Shalaby","sequence":"additional","affiliation":[{"name":"Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5461-7247","authenticated-orcid":true,"given":"N.A. Mark","family":"Estes III","sequence":"additional","affiliation":[{"name":"Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5815-370X","authenticated-orcid":true,"given":"Sandeep","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4669-803X","authenticated-orcid":true,"given":"Samir","family":"Saba","sequence":"additional","affiliation":[{"name":"Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.086843"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2016.01.011"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2011.07.017"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2009.01.358"},{"key":"e_1_3_3_6_2","first-page":"249","article-title":"Diastolic dysfunction in diabetes mellitus.","volume":"3","author":"Dikshit NM","year":"2013","unstructured":"Dikshit NM, Wadia PZ, Shukla DK. 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