Computed Tomography Perfusion Identifies Patients With Stroke With Impaired Cardiac Function

Abstract

Background and Purpose— Low left ventricular ejection fraction (LVEF) leads to worse outcomes after stroke. We hypothesized that the arterial input function (AIF) variability on perfusion computed tomography, especially the time between scan onset and end of AIF (SO-EndAIF), would reflect reduction of cardiac output. Methods— Retrospective analysis of consecutive stroke patients, who underwent computed tomography between January 2013 and September 2018, was performed in 2 parts. (1) To determine the correlation between SO-EndAIF and LVEF, all patients with a transthoracic echocardiogram performed ±6 months from the time of stroke were included. LVEF was dichotomized as either normal (≥50%) or decreased (<50%). (2) AIF was compared with hypoperfusion volume, defined as delay time >3 seconds and with clinical outcome measured using 3-month modified Rankin Scale. Results— A total of 732 ischemic stroke patients underwent computed tomography, 231 with transthoracic echocardiogram were included in part (1), 393 with outcome data were included in part (2). In part (1), 193/231 (83.5%) had normal LVEF (median 61%) and 38/231 (16.5%) decreased LVEF (median 39%). The low-LVEF group had significantly prolonged SO-EndAIF compared with normal-LVEF group (mean of 39.7 versus 26 second; P <0.001), and larger hypoperfusion lesions (94.9 versus 37.6 mL; P <0.001). SO-EndAIF time was strongly associated with EF, with an area under the curve of 0.86. Twenty nine seconds was the best threshold to distinguish between normal and impaired EF (area under the curve, 0.77). In part (2), the SO-EndAIF ≥29 second group had larger hypoperfusion volumes (21.8 versus 89.7 mL; P <0.001) and infarct core (12.2 versus 2.3 mL; P <0.0001) and patients with SO-EndAIF ≥29 seconds had fewer excellent or good clinical outcomes (modified Rankin Scale score 0–1; 40% versus 22%; OR, 2.79; P <0.001, modified Rankin Scale score 0–2; 65% versus 35%; OR, 1.41; P =0.033). Conclusions— AIF width correlates with ejection fraction in acute ischemic stroke. A 29-second threshold from scan onset to end of AIF accurately predicts reduced LVEF and identifies patients more likely to have worse outcomes after stroke.

Left ventricular ejection fraction and right atrial diameter are associated with deep regional CBF in arteriosclerotic cerebral small vessel disease

“…We propose that echocardiographic and deep regional CBF assessment should be attached importance in the prognostic evaluation of aCSVD patients absent from heart failure. Previous study indicates that lower LVEF prolongs arterial input function and contributes to larger hypoperfusion volumes as well as poorer poststroke outcome [24]. Though the present study enrolled an aCSVD population with normal LVEF, we have revealed an independent positive linear correlation between deep regional CBF and LVEF after adjustment of conventional cerebrovascular risk factors including age, hypertension, Recent systemic review and meta-analysis confirms global CBF reduction in CSVD patients especially for those with WMH [25].…”

Reduced Ejection Fraction and Augmented Right Atrium are Independent Risk Factors of Deep Regional CBF in Cerebral Small Vessel Disease

“…The value of LVEF, a well-established predictor for left ventricular systolic function was positively associated with deep CBF after adjustment of conventional cerebrovascular risk factors including age, hypertension, symptomatic stroke and eGFR in CSVD patients. Low LVEF prolongs arterial input function and contributes to larger hypoperfusion volumes as well as poorer poststroke outcome (19). In addition, LVFS another index of left ventricular systolic function was positively associated with deep regional CBF.…”

“…In total, 103 patients including 64 males (62.1%, mean age 63.00 ± 11.57 year) and 39 females (37.9%, mean age 63.56 ± 12.27 year) were included into the present study. Among this study population, primary causes for admission were listed brie y as follow: "lacunar stroke" (33, 32.0%), "gait disturbance or bradykinesia" (23, 22.3%), "cognition decline" (14, 13.6%), "anxiety or depression" (14, 13.6%), mixed symptoms of above (19,18.4%). The clinical characteristics including demographic information, and laboratory biomedical factors between CSVD Burden low and CSVD Burden high groups were summarized in Table 1.…”

Blood Pressure Management in Acute Ischemic Stroke

“…A novel study found that multimodal brain imaging performed in acute stroke may accurately predict reduced left ventricle ejection fraction (LVEF). The arterial input function width on perfusion computed tomography has been shown to correlate with LVEF in AIS and to identify patients with a reduced LVEF and increased risk of worse clinical outcome 3 months after the event [122].…”