Key result
LVEF < 50% during ischemic stroke thrombolysis is linked to ~41% worse 3-month functional outcomes.
Why the study?
Little is known about how left ventricular systolic dysfunction affects functional and clinical outcomes in acute ischemic stroke patients undergoing thrombolysis.
Does left ventricular systolic dysfunction (LVEF < 50%) worsen functional and clinical outcomes in acute ischemic stroke patients undergoing thrombolysis?
Observational (n=937)
Does left ventricular systolic dysfunction (LVEF < 50%) worsen functional and clinical outcomes in acute ischemic stroke patients undergoing thrombolysis?
Effect estimate: adjusted OR 1.41 (95% CI 1.03-1.92)
p-value: p=0.030
In acute ischemic stroke patients undergoing thrombolysis, pre-existing left ventricular systolic dysfunction is associated with increased mortality, subsequent heart failure admission, myocardial infarction, and poorer functional outcomes.
May warrant closer monitoring in LVSD patients undergoing thrombolysis; leaves open whether cardiac optimization improves outcomes.
(1) Background: Little is known about how left ventricular systolic dysfunction (LVSD) affects functional and clinical outcomes in acute ischemic stroke (AIS) patients undergoing thrombolysis; (2) Methods: A retrospective observational study conducted between 2006 and 2018 included 937 consecutive AIS patients undergoing thrombolysis. LVSD was defined as left ventricular ejection fraction (LVEF) < 50%. Univariate and multivariate binary logistic regression analysis was performed for demographic characteristics. Ordinal shift regression was used for functional modified Rankin Scale (mRS) outcome at 3 months. Survival analysis of mortality, heart failure (HF) admission, myocardial infarction (MI) and stroke/transient ischemic attack (TIA) was evaluated with a Cox-proportional hazards model; (3) Results: LVSD patients in comparison with LVEF ≥ 50% patients accounted for 190 and 747 patients, respectively. LVSD patients had more comorbidities including diabetes mellitus (100 (52.6%) vs. 280 (37.5%), p < 0.001), atrial fibrillation (69 (36.3%) vs. 212 (28.4%), p = 0.033), ischemic heart disease (130 (68.4%) vs. 145 (19.4%), p < 0.001) and HF (150 (78.9%) vs. 46 (6.2%), p < 0.001). LVSD was associated with worse functional mRS outcomes at 3 months (adjusted OR 1.41, 95% CI 1.03–1.92, p = 0.030). Survival analysis identified LVSD to significantly predict all-cause mortality (adjusted HR [aHR] 3.38, 95% CI 1.74–6.54, p < 0.001), subsequent HF admission (aHR 4.23, 95% CI 2.17–8.26, p < 0.001) and MI (aHR 2.49, 95% CI 1.44–4.32, p = 0.001). LVSD did not predict recurrent stroke/TIA (aHR 1.15, 95% CI 0.77–1.72, p = 0.496); (4) Conclusions: LVSD in AIS patients undergoing thrombolysis was associated with increased all-cause mortality, subsequent HF admission, subsequent MI and poorer functional outcomes, highlighting a need to optimize LVEF.
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Chee et al. (2023) conducted an observational in Acute ischemic stroke (n=937). Left ventricular systolic dysfunction (LVEF < 50%) vs. LVEF ≥ 50% was evaluated on Functional modified Rankin Scale (mRS) outcome at 3 months (adjusted OR 1.41, 95% CI 1.03-1.92, p=0.030). Left ventricular systolic dysfunction (LVEF < 50%) in acute ischemic stroke patients undergoing thrombolysis was associated with worse functional outcomes at 3 months (adjusted OR 1.41; 95% CI 1.03-1.92; p=0.030).
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