Left ventricular systolic dysfunction is associated with poor functional outcomes after endovascular thrombectomy

Abstract

BackgroundEndovascular thrombectomy (ET) has transformed acute ischemic stroke (AIS) therapy in patients with large vessel occlusion (LVO). Left ventricular systolic dysfunction (LVSD) decreases global cerebral blood flow and predisposes to hypoperfusion. We evaluated the relationship between LVSD, as measured by LV ejection fraction (LVEF), and clinical outcomes in patients with anterior cerebral circulation LVO who underwent ET.MethodsThis multicenter retrospective cohort study examined anterior circulation LVO AIS patients from six international stroke centers. LVSD was measured by assessment of the echocardiographic LVEF using Simpson’s biplane method of discs according to international guidelines. LVSD was defined as LVEF <50%. The primary outcome was defined as a good functional outcome using a modified Rankin Scale (mRS) of 0–2 at 3 months.ResultsWe included 440 AIS patients with LVO who underwent ET. On multivariate analyses, pre-existing diabetes mellitus (OR 2.05, 95% CI 1.24 to 3.39;p=0.005), unsuccessful reperfusion (Treatment in Cerebral Infarction (TICI) grade 0-2a) status (OR 4.21, 95% CI 2.04 to 8.66; p<0.001) and LVSD (OR 2.08, 95% CI 1.18 to 3.68; p=0.011) were independent predictors of poor functional outcomes at 3 months. On ordinal (shift) analyses, LVSD was associated with an unfavorable shift in the mRS outcomes (OR 2.32, 95% CI 1.52 to 3.53; p<0.001) after adjusting for age and ischemic heart disease.ConclusionAnterior circulation LVO AIS patients with LVSD have poorer outcomes after ET, suggesting the need to consider cardiac factors for ET, the degree of monitoring and prognostication post-procedure.

Left Ventricular Diastolic Dysfunction Is Associated with Poor Functional Outcomes after Endovascular Thrombectomy

“…This may be explained by the shared pathophysiology between LVO strokes and ischaemic heart disease [ 24 ]. Studies have also shown that cardiac diseases, in particular LVSD, are associated with higher rates of in-hospital mortality and poorer functional outcomes [ 6 , 28 ]. This effect remains significant even after adjusting comorbidities such as age, and previous ischaemic heart disease as well as the efficacy and rate of ET.…”

“…Cardiovascular diseases including ischaemic heart disease are common in stroke patients probably due to similar underlying comorbidities and a shared pathophysiology [ 5 ]. Left ventricular systolic dysfunction (LVSD) is often seen in patients with LVO AIS and such impaired cardiac function increases the risk of poor neurologic and functional outcomes after ET [ 6 , 7 , 8 ]. However, the role of left ventricular diastolic dysfunction (LVDD) remains unclear.…”

Left ventricular systolic dysfunction predicts clinical prognosis in patients with acute ischemic stroke after intravenous thrombolysis

“…Left ventricular systolic dysfunction (LVSD) has been reported as an important clinical predictor of higher morbidity and mortality in AIS patients [ 7 , 8 ]. Left ventricular ejection fraction (LVEF) is a common parameter for the evaluation of left ventricular systolic function, and is widely used in clinical diagnosis and experimental research [ 9 – 11 ].…”

“…Left ventricular ejection fraction (LVEF) is a common parameter for the evaluation of left ventricular systolic function, and is widely used in clinical diagnosis and experimental research [ 9 – 11 ]. Previous studies prior to IVT or ET have indicated that reduced LVEF was associated with higher NIHSS scores at admission, poorer functional outcomes and higher in-hospital mortality rates [ 8 , 12 ]. LVSD may involve in the pathophysiology of AIS through different mechanisms.…”

Knowledge, Attitude and Practice towards COVID 19 prevention and precaution among non-teaching faculty in a private dental institution.

“…Special attention dedicated to patients suffering from cancer, whose immune system is compromised either due to treatment or disease itself (6). As such many health care systems have been overwhelmed with depression and anxiety (7). There is a potential shortage in physical resources, such as ventilators, needed to care for surges of critical ill patients (8).…”