Estimated Pulse Wave Velocity Predicts Outcomes After Acute Ischemic Stroke: A Multinational Cohort Analysis

Area of Science:

• Cardiology
• Neurology
• Vascular Medicine

Background:

• Estimated pulse wave velocity (ePWV), a proxy for carotid to femoral pulse wave velocity (cfPWV), is calculable from 24-hour blood pressure monitoring (24h-BPM).
• The prognostic value of ePWV in acute ischemic stroke (AIS) has not been extensively studied in large international patient groups.

Purpose of the Study:

• To investigate the association between ePWV and clinical characteristics, stroke severity, etiologic subtypes, and functional outcomes in a large multinational cohort of AIS patients.
• To determine if ePWV is an independent predictor of poor functional outcome after AIS.

Main Methods:

• A pooled analysis of individual patient data from 13 cohorts across seven countries, including 2,933 AIS patients who underwent 24h-BPM.
• ePWV was calculated using a validated equation, and logistic regression was employed to assess associations with outcomes.
• The primary outcome was poor functional outcome at 90 days, defined as a modified Rankin Scale (mRS) score >2.

Main Results:

• Patients with higher ePWV exhibited more severe strokes (median NIHSS 7 vs. 3) and poorer functional outcomes at 90 days (63.7% vs. 23.7%) and discharge (61.9% vs. 29.1%).
• Each 1 m/s increase in ePWV was significantly associated with poor functional outcome at 90 days (aOR: 1.24) and discharge (aOR: 1.26), independent of conventional risk factors and stroke severity.
• In younger patients (≤50 years), elevated ePWV was most pronounced in those with small vessel disease (SVD), who also presented with a higher burden of cardiovascular risk factors.

Conclusions:

• ePWV, derived from 24h-BPM, is a practical and broadly applicable measure reflecting vascular aging.
• ePWV is significantly associated with functional outcomes in patients following acute ischemic stroke.
• Elevated ePWV in young SVD patients suggests an early arteriosclerotic process contributing to stroke risk in this subgroup.