Prediction of trends in unfavorable prognosis in patients with acute ischemic stroke according to low left ventricular ejection fraction levels

Abstract

As few studies have reported the impact of lower left ventricular ejection fraction (LVEF) on the prognosis of acute ischemic stroke (AIS) patients, we aimed to explore this through a retrospective cohort study and a meta-analysis. A total of 283 AIS patients receiving intravenous thrombolysis at the Third Affiliated Hospital of Wenzhou Medical University between 2016 and 2019 were enrolled and divided into three groups based on LVEF tertiles. The logistic regression model estimated the association between LVEF and the three-month AIS prognosis. After adjusting for confounding factors, patients in tertile 3 exhibited an increased risk of poor functional outcome and mortality [odds ratio (OR), 2.656 (95% CI: 1.443-4.889); OR, 7.586 (95% CI: 2.102-27.375)]. A systematic search of PubMed, EMBASE and Cochrane Library was performed. Our meta-analysis revealed that LVEF < 40% was significantly associated with poor functional outcome [OR 1.94 (95% CI: 1.08-3.50)], mortality [OR 3.69 (95% CI: 1.22-11.11)], as well as LVEF < 55% [OR 1.68 (95% CI: 1.22-2.32); 2.27 (95% CI: 1.30-3.96)], respectively. A decreased LVEF could predict an inferior prognosis for AIS; therefore, it could aid in clinical decision-making in this patient population.

Keywords: Left ventricular ejection fraction; acute ischemic stroke; cardioembolic stroke; meta-analysis; prognosis.

Figure 1.

Mediation analysis was displayed for the presence of LVEF as a mediator in the relation between (a), atrial fibrillation and three months mRS and (b), mitral regurgitation and three months mRS.

Figure 2.

Adjusted association of left ventricular ejection fraction (LVEF) changes after intravenous thrombolysis with adverse outcome (a): three-month poor outcome and (b): three-month death. Notes: The solid line indicates the odds ratio (OR), while the shadow indicates 95% CI. The reference point was set to 60. Multiple spline regression analyses with four knots (at the 5th, 35th, 65th, and 95th percentiles). Data were adjusted for age, sex, history of smoking, drinking, hypertension, atrial fibrillation, hyperlipidemia and NIHSS score at admission.

Figure 3.

Forest plots of meta-analysis pooling odds ratio (OR) for the association between different LVEF levels (35%, 40%, 50% and 55%) and risk of poor functional outcome of AIS patients (a) and Forest plots pooling OR for the association between different LVEF cut-off values (35%, 40%, 55% and 62%) and risk of mortality of AIS patients (b).