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.
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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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