Left ventricular systolic dysfunction is associated with poor functional outcomes after endovascular thrombectomy
Kölner Universitäts PublikationsServer (Universität zu Köln)
Abstract
Background Endovascular 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. Methods This 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. Results We 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. Conclusion Anterior 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.
Authors 33
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National University of Singapore · National University Health System
Affiliation as printed
National University Health System
National University Singapore Yong Loo Lin School of Medicine
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National University Health System
Affiliation as printed
National University Health System, Singapore
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Chang Gung Memorial Hospital · Linkou Chang Gung Memorial Hospital
Affiliation as printed
Chang Gung Memorial Hospital Linkou Main Branch
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Karolinska University Hospital · Karolinska Institutet
Affiliation as printed
Departments of Neuroradiology, Karolinska University Hospital and Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Affiliation as printed
Departments of Neuroradiology
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Karolinska University Hospital · Karolinska Institutet
Affiliation as printed
Departments of Neuroradiology, Karolinska University Hospital and Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Chang Gung University · Chang Gung Memorial Hospital · Linkou Chang Gung Memorial Hospital
Affiliation as printed
College of Medicine and School of Medical Technology, Chang Gung University
Division of Neuroradiology Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital; Linkou,Taiwan
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Linkou Chang Gung Memorial Hospital
Affiliation as printed
Division of Neuroradiology, Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Linkou, Taiwan
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Linkou Chang Gung Memorial Hospital
Affiliation as printed
Division of Neuroradiology, Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Linkou, Taiwan
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National University of Singapore
Affiliation as printed
National University Singapore Yong Loo Lin School of Medicine
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National University of Singapore · National University Heart Centre Singapore
Affiliation as printed
National University Heart Centre, Singapore
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National University of Singapore
Affiliation as printed
National University Singapore Yong Loo Lin School of Medicine Singapore
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National University of Singapore
Affiliation as printed
National University Singapore Yong Loo Lin School of Medicine
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National University of Singapore · National University Health System
Affiliation as printed
National University Health System
National University Singapore Yong Loo Lin School of Medicine
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National University of Singapore · National University Health System
Affiliation as printed
National University Health System
National University Singapore Yong Loo Lin School of Medicine
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National University of Singapore · National University Health System
Affiliation as printed
National University Health System
National University Singapore Yong Loo Lin School of Medicine
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National University of Singapore · National University Health System
Affiliation as printed
National University Health System
National University Singapore Yong Loo Lin School of Medicine
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National University of Singapore · National University Health System
Affiliation as printed
National University Health System
National University Singapore Yong Loo Lin School of Medicine
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National University of Singapore · National University Health System
Affiliation as printed
National University Health System
National University Singapore Yong Loo Lin School of Medicine
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Affiliation as printed
Department of Radiology, Neuroradiology and Nuclear Medicine, University Medical Center Langendreer, Bochum, Germany
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Affiliation as printed
Neuroradiology, University Hospital Cologne, Cologne, Germany
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Affiliation as printed
Neuroradiology, Rheinisch Westfalische Technische Hochschule Aachen, Aachen, Germany
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Affiliation as printed
Department of Interventional Neuroradiology, Royal London Hospital, London, UK
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Affiliation as printed
Department of Interventional Neuroradiology, Royal London Hospital, London, UK
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Affiliation as printed
Department of Interventional Neuroradiology, Royal London Hospital, London, UK
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Affiliation as printed
Department of Neurology, Royal London Hospital, London, UK
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Affiliation as printed
Department of Neurology, Royal London Hospital, London, UK
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Affiliation as printed
Department of Neurology, Royal London Hospital, London, UK
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Affiliation as printed
Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
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Affiliation as printed
Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
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Affiliation as printed
Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
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National University of Singapore · National University Health System
Affiliation as printed
National University Health System
National University Singapore Yong Loo Lin School of Medicine
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National University of Singapore · National University Health System
Affiliation as printed
National University Health System
National University Singapore Yong Loo Lin School of Medicine