Impact of Heart Failure on Prognosis in Acute Ischemic Stroke Following Thrombectomy

Introduction Acute ischemic stroke (AIS) remains one of the leading causes of mortality and long‐term disability worldwide. Mechanical thrombectomy (MT) has emerged as the standard of care for large vessel occlusions, significantly improving recanalization rates and functional outcomes. However, patient prognosis after MT is not solely determined by procedural success but is also influenced by comorbid conditions. Heart failure (HF) is a prevalent comorbidity in stroke patients, associated with impaired cerebral perfusion, systemic inflammation, and increased thromboembolic risk. Despite these associations, limited evidence exists regarding the impact of HF on outcomes after MT. This study aimed to evaluate the prognostic significance of HF in AIS patients undergoing MT. Materials and Methods We conducted a retrospective observational study at Eskişehir Osmangazi University Stroke Center, including 257 consecutive AIS patients who underwent MT between 2019 and 2024. Patients were divided into two groups according to the presence or absence of HF, defined as left ventricular ejection fraction (LVEF) <40% documented by echocardiography. Demographic, clinical, radiological, and laboratory data were collected. The primary outcomes were successful recanalization (mTICI ≥ 2b), functional independence at 90 days (mRS ≤2), and 90‐day mortality. Statistical analyses included chi‐square tests, Mann‐Whitney U tests, and multivariate logistic regression to identify independent predictors of mortality. Results Among 257 patients, 84 (32.7%) had HF. There were no significant differences between groups in age or baseline NIHSS scores (p>0.05). Male predominance was more pronounced in the HF group (72.6% vs. 32.9%, p<0.001). Radiological evaluation revealed significantly poorer collateral circulation in patients with HF (p=0.009). Rates of successful recanalization (69% vs. 61.3%, p=0.224) and first‐pass effect (40.5% vs. 44.5%, p=0.540) did not differ significantly. At discharge and 90‐day follow‐up, mRS distributions were similar between groups (p=0.405 and p=0.505, respectively). Mortality within 90 days was higher in HF patients (23.4% vs. 13.4%), although this did not reach statistical significance (p=0.054). However, in multivariate logistic regression, HF emerged as an independent predictor of 90‐day mortality (OR: 3.239; 95% CI: 1.354‐7.751; p=0.008), along with female sex (OR: 2.806; p=0.023), higher baseline NIHSS (OR: 1.172; p<0.001), and ASPECTS ≤7 (OR: 3.348; p=0.010). Subgroup analysis according to LVEF (<30%, 30‐40%, 40‐50%) revealed no significant differences in functional outcomes or mortality (p>0.05). Conclusion Our study demonstrates that while HF does not significantly affect recanalization success or short‐term functional outcomes after MT, it independently increases the risk of 90‐day mortality in AIS patients. The association of HF with poorer collateral circulation suggests a potential pathophysiological mechanism that may exacerbate cerebral vulnerability during ischemic events. These findings underscore the importance of careful cardiovascular evaluation and tailored management strategies in stroke patients with HF. Further prospective, multicenter studies are warranted to validate these results and to determine whether optimization of cardiac function can improve stroke outcomes in this high‐risk population.