Predictive Value of Epicardial Adipose Tissue for Hemorrhagic Transformation and Functional Outcomes in Acute Ischemic Stroke Patients Undergoing Intravenous Thrombolysis Therapy

Hemorrhagic transformation (HT) is a severe complication in patients with acute ischemic stroke (AIS) undergoing intravenous thrombolysis therapy (IVT). Epicardial adipose tissue (EAT) contributes to the development of AIS and the disruption of the blood-brain barrier. This study aims to investigate the relationship between EAT and the risk of HT, as well as functional outcomes, in AIS patients treated with IVT.

230 AIS patients were included. Epicardial adipose tissue volume (EATV) and EAT attenuation were measured from chest CT scans. Follow-up cranial CT or magnetic resonance imaging (MRI) assessed HT occurrence. Patients were stratified into groups based on the presence of HT or parenchymal hematoma (PH), and their 90-day functional outcomes (evaluated by the modified Rankin Scale).

HT occurred in 52 (22.61%) patients, including 28 (12.17%) patients with PH, 85 (37.00%) patients had poor 90-day functional prognosis. Compared to the first quartile of EATV, the third quartile (OR 9.254, 95% CI 1.533-55.853) and the fourth quartile (OR 11.117, 95% CI 1.925-64.211) of EATV were independent predictors of HT; and EATV as a continuous variable (OR 1.022, 95% CI 1.005-1.040) was an independent risk factor for PH. Higher EAT attenuation was independently associated with poor prognosis (OR 1.170, 95% CI 1.056-1.297). The area under curve for predicting HT, PH and 90-day poor functional outcome was 0.705 (95% CI 0.632-0.778), 0.693 (95% CI 0.597-0.789), and 0.720 (95% CI 0.653-0.787).

The study demonstrates that EAT is associated with HT and poor 90-day outcomes in AIS patients undergoing IVT.