Left ventricular systolic dysfunction predicts clinical prognosis in patients with acute ischemic stroke after intravenous thrombolysis

Abstract

Background: Although intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis is the most effective early treatment for acute ischemic stroke (AIS), outcomes vary greatly among patients. Left ventricular systolic dysfunction (LVSD) is prone to distant organ ischemia and may be a predictor for poor prognosis in AIS patients undergoing intravenous thrombolysis (IVT). Our aim was to investigate the predictivity of LVSD diagnosis (as measured by left ventricular ejection fraction (LVEF)) on 90-day clinical outcomes in AIS patients undergoing thrombolysis.

Methods: The current prospective cohort study continuously enrolled 273 AIS patients from the National Stroke Prevention and Treatment Engineering Management Special Database who underwent IVT and completed echocardiography within 24 h of admission between 2021 and 2023. LVSD was examined by evaluation of the echocardiographic LVEF values using Simpson's biplane method of discs in line with international guidelines, and defined as a LVEF value < 50%. Multivariable ordinal logistic regression model was performed to analyze the association between LVEF and functional outcome at 3 months. Restricted cubic spline (RCS) was used to examine the shape of the dose-response association between reduced LVEF and poor functional outcomes. Subgroup analysis was also employed to further verify the reliability and practicability of the results.

Results: Baseline data analysis showed LVSD patients had more comorbidities including on multivariate analyses, LVSD (OR 2.78, 95% CI 1.23 to 6.24, P=0.014), pre-existing diabetes mellitus (OR 2.08, 95% CI 1.11 to 3.90, P=0.023) and NIHSS on arrival (OR 1.31, 95% CI 1.21 to 1.49, P<0.001) were independent predictors of poor functional outcomes (mRS ≥ 3) at 3 months. Multivariable-adjusted spline regression indicated a linear dose-response association between LVEF after IVT and poor functional outcomes (p for linearity < 0.001), with the optimal cutoff values of LVEF being 0.48.

Conclusions: Our finding indicated that AIS patients with LVSD after IVT had poorer outcomes, suggesting the need to monitor and optimize LVEF in stroke management.

Keywords: acute ischemic stroke; intravenous thrombolysis; left ventricular ejection fraction; left ventricular systolic dysfunction; outcome.

Figure 1

Flowchart of study population selection. rt-PA, recombinant tissue plasminogen activator; EVT, Endovascular therapy; TTE, Transthoracic echocardiography.

Figure 2

Distribution of mRS scores at three months according to LVEF levels after IVT in AIS patients. LVEF, left ventricular ejection function.

Figure 3

Adjusted ORs of the 3-month primary outcome according to LVEF levels after IVT. OR and 95% CI derived from restricted cubic spline regression, with knots placed at the 5th, 35th, 65th, and 95th percentiles of the levels of LVEF after IVT.

Figure 4

Subgroup analyses for poor outcomes by LVEF after IVT. NIHSS, National Institutes of Health Stroke Scale; DM, Diabetes mellitus; CHD, Coronary heart disease.