RT Journal Article
SR Electronic
T1 Left ventricular systolic dysfunction is associated with poor functional outcomes after endovascular thrombectomy
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 515
OP 518
DO 10.1136/neurintsurg-2020-016216
VO 13
IS 6
A1 Benjamin Y Q Tan
A1 Aloysius ST Leow
A1 Tsong-Hai Lee
A1 Vamsi Krishna Gontu
A1 Tommy Andersson
A1 Staffan Holmin
A1 Ho-Fai Wong
A1 Chuan-Min Lin
A1 Chih-Kuang Cheng
A1 Ching-Hui Sia
A1 Nicholas Ngiam
A1 Zhi-Xuan Ng
A1 Joshua Yeo
A1 Bernard Chan
A1 Hock-Luen Teoh
A1 Raymond Seet
A1 Prakash Paliwal
A1 Gopinathan Anil
A1 Cunli Yang
A1 Volker Maus
A1 Nuran Abdullayev
A1 Anastasios Mpotsaris
A1 Pervinder Bhogal
A1 Ken Wong
A1 Hegoda Levansri Dilrukshan Makalanda
A1 Oliver Spooner
A1 Sageet Amlani
A1 Daniel Campbell
A1 Robert Michael
A1 Ulf Quäschling
A1 Stefan Schob
A1 Jens Maybaum
A1 Vijay Kumar Sharma
A1 Leonard LL Yeo
YR 2021
UL http://jnis.bmj.com/content/13/6/515.abstract
AB 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.Data relevant to the study are included in the article or uploaded as supplementary information. Additional data is available on email request.