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Left ventricular systolic dysfunction is associated with poor functional outcomes after endovascular thrombectomy
  1. Benjamin Y Q Tan1,2,
  2. Aloysius ST Leow1,
  3. Tsong-Hai Lee3,
  4. Vamsi Krishna Gontu4,
  5. Tommy Andersson4,5,
  6. Staffan Holmin4,
  7. Ho-Fai Wong6,7,
  8. Chuan-Min Lin8,
  9. Chih-Kuang Cheng8,
  10. Ching-Hui Sia2,9,
  11. Nicholas Ngiam9,
  12. Zhi-Xuan Ng2,
  13. Joshua Yeo2,9,
  14. Bernard Chan1,2,
  15. Hock-Luen Teoh1,2,
  16. Raymond Seet1,2,
  17. Prakash Paliwal1,2,
  18. Gopinathan Anil1,2,
  19. Cunli Yang1,2,
  20. Volker Maus10,
  21. Nuran Abdullayev11,
  22. Anastasios Mpotsaris12,
  23. Pervinder Bhogal13,
  24. Ken Wong13,
  25. Hegoda Levansri Dilrukshan Makalanda13,
  26. Oliver Spooner14,
  27. Sageet Amlani14,
  28. Daniel Campbell14,
  29. Robert Michael14,
  30. Ulf Quäschling15,
  31. Stefan Schob15,
  32. Jens Maybaum15,
  33. Vijay Kumar Sharma1,2,
  34. Leonard LL Yeo1,2
  1. 1National University Health System, Singapore
  2. 2National University Singapore Yong Loo Lin School of Medicine, Singapore
  3. 3Stroke Center and Department of Neurology, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan 333, Taiwan
  4. 4Departments of Neuroradiology, Karolinska University Hospital and Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
  5. 5Departments of Radiology and Neurology, AZ Groeninge, Kortrijk, Belgium
  6. 6Neuroradiology, Division of Neuroradiology Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital; Linkou,Taiwan, Taoyuan, Guishan District, Taiwan
  7. 7College of Medicine and School of Medical Technology, Chang Gung University, Taoyuan, Taiwan
  8. 8Division of Neuroradiology, Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Linkou, Taiwan
  9. 9National University Heart Centre, Singapore
  10. 10Department of Radiology, Neuroradiology and Nuclear Medicine, University Medical Center Langendreer, Bochum, Germany
  11. 11Neuroradiology, University Hospital Cologne, Cologne, Germany
  12. 12Neuroradiology, Rheinisch Westfalische Technische Hochschule Aachen, Aachen, Germany
  13. 13Department of Interventional Neuroradiology, Royal London Hospital, London, UK
  14. 14Department of Neurology, Royal London Hospital, London, UK
  15. 15Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
  1. Correspondence to Professor Tsong-Hai Lee, Stroke Center and Department of Neurology, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan 333, Taiwan; thlee{at}


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.

  • stroke
  • thrombectomy

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  • BYQT and ASL contributed equally.

  • Contributors All co-authors made significant contributions to the planning, conduct, reporting and final approval of the study.

  • Funding Tsong-Hai Lee was funded by Chang Gung Medical Research Council and Grant (CMRPG3J1161). Leonard LL Yeo was funded by National Medical Research Council Singapore (NMRC/MH 095:003/008-223).

  • Competing interests AM: Consultancy for Stryker, Phenox and Perflow. TA: Consultancy for Ablynx, Amnis Therapeutics, Anaconda, Cerenovus, Medtronic, Rapid Medical.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval was obtained from the following institutional review board(s) or ethics committee(s): Singapore DSRB 2010/00509, Taiwan IRB No. 201900048B0, Regionala etikprovningsnamnden i Stockholm Diarienr: 2016/1041-31/4, IRB nr. AZ 208-15-0010062015. All participants gave informed consent before taking part in the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data relevant to the study are included in the article or uploaded as supplementary information. Additional data is available on email request.

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