Computed Tomography Perfusion Identifies Patients With Stroke With Impaired Cardiac Function

Area of Science:

• Neurology
• Cardiology
• Radiology

Background:

• Low left ventricular ejection fraction (LVEF) is associated with poorer outcomes following stroke.
• Assessing cardiac function is crucial for stroke patient management.

Purpose of the Study:

• To investigate the correlation between arterial input function (AIF) variability on perfusion CT and LVEF.
• To determine if AIF parameters can predict reduced cardiac output and stroke outcomes.

Main Methods:

• Retrospective analysis of 732 ischemic stroke patients undergoing CT.
• Correlation of AIF time (scan onset to end of AIF - SO-EndAIF) with LVEF from echocardiography in 231 patients.
• Comparison of SO-EndAIF with hypoperfusion volume and 3-month modified Rankin Scale outcomes in 393 patients.

Main Results:

• Patients with decreased LVEF (<50%) had significantly prolonged SO-EndAIF (mean 39.7s vs 26s) and larger hypoperfusion lesions.
• SO-EndAIF time strongly correlated with LVEF (AUC 0.86), with a 29-second threshold effectively distinguishing normal from impaired EF (AUC 0.77).
• SO-EndAIF ≥29 seconds was linked to larger hypoperfusion and infarct core volumes, and poorer clinical outcomes (mRS 0-1: 22% vs 40%).

Conclusions:

• Arterial input function (AIF) width on CT perfusion imaging correlates with ejection fraction in acute ischemic stroke.
• A 29-second SO-EndAIF threshold accurately predicts reduced LVEF.
• This AIF duration can identify stroke patients at higher risk for worse clinical outcomes.