Estimated pulse wave velocity predicts outcomes after acute ischemic stroke: a multinational cohort analysis

BACKGROUND: Estimated pulse wave velocity (ePWV), an easy to calculate proxy of carotid to femoral PWV (cfPWV), can be derived from 24-hour blood pressure monitoring (24h-BPM). Its role in acute ischemic stroke (AIS) has not previously been investigated in large multinational datasets. METHODS: A pooled individual patient data analysis from 13 cohorts across seven countries was conducted, including 2,933 AIS patients who underwent 24h-BPM during the hyperacute to subacute phase. ePWV was calculated using a validated equation. Associations with clinical characteristics, stroke severity, etiologic subtypes, and outcomes were assessed with logistic regression. The primary outcome was poor functional outcome at 90 days, defined as a modified Rankin Scale (mRS) >2. RESULTS: Patients with higher ePWV presented with more severe strokes (median NIHSS 7 vs. 3, P < .001) and had poorer outcomes both at 90 days (63.7% vs. 23.7%, P < .001) and discharge (61.9% vs 29.1%, P < .001). ePWV was associated with poor outcome at 90 days (aOR: 1.24, 95% CI: 1.05-1.45) and discharge (aOR: 1.26, 95% CI: 1.12-1.42), per 1 m/s increase in ePWV, after adjustment for conventional risk factors and stroke severity. In patients ≤50 years, ePWV was highest in those with small vessel disease (SVD), who also had more cardiovascular risk factors than other stroke subtypes. CONCLUSIONS: ePWV derived from 24h-BPM is a simple, widely applicable measure of vascular aging that is associated with functional outcome after AIS. The higher ePWV observed in young patients with SVD underscores a potential early arteriosclerotic burden in this subgroup.