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

Benjamin Y Q Tan1,2, Aloysius St Leow1, Tsong-Hai Lee3

  • 1National University Health System, Singapore.

Journal of Neurointerventional Surgery
|September 5, 2020
PubMed

Insights

Left ventricular systolic dysfunction (LVSD) is linked to worse outcomes in acute ischemic stroke (AIS) patients undergoing endovascular thrombectomy (ET) for large vessel occlusion (LVO). This highlights the importance of cardiac assessment in stroke treatment and recovery.

Area of Science:

  • Cardiology
  • Neurology
  • Stroke Medicine

Background:

  • Endovascular thrombectomy (ET) has revolutionized acute ischemic stroke (AIS) treatment for large vessel occlusion (LVO).
  • Left ventricular systolic dysfunction (LVSD) can impair cerebral blood flow, potentially affecting stroke outcomes.
  • The impact of LVSD on patients undergoing ET for anterior circulation LVO requires further investigation.

Purpose of the Study:

  • To evaluate the relationship between LVSD, assessed by left ventricular ejection fraction (LVEF), and clinical outcomes in AIS patients with anterior circulation LVO treated with ET.
  • To identify predictors of functional outcomes following ET in this patient population.

Main Methods:

  • A multicenter retrospective cohort study involving 440 AIS patients with LVO who underwent ET.
  • LVSD was defined as LVEF <50%, measured using echocardiography.
  • The primary outcome was a good functional outcome (modified Rankin Scale [mRS] 0-2) at 3 months.

Main Results:

  • LVSD was an independent predictor of poor functional outcomes at 3 months post-ET (OR 2.08, 95% CI 1.18 to 3.68; p=0.011).
  • Unsuccessful reperfusion (TICI grade 0-2a) and pre-existing diabetes mellitus were also associated with poorer outcomes.
  • LVSD showed an unfavorable shift in mRS outcomes (OR 2.32, 95% CI 1.52 to 3.53; p<0.001) after adjustment.

Conclusions:

  • Patients with anterior circulation LVO AIS and LVSD experience worse outcomes after ET.
  • Cardiac factors, including LVSD, should be considered in the management, monitoring, and prognostication of stroke patients undergoing ET.
  • Further research may explore targeted cardiac interventions to improve outcomes in these patients.
Abstract

Keywords:
strokethrombectomy

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