Left Ventricular Diastolic Dysfunction Is Associated with Poor Functional Outcomes after Endovascular Thrombectomy

TL;DR

Heart diastolic dysfunction is linked to worse recovery after stroke treatment with endovascular thrombectomy.

Contribution

This study is the first to show that left ventricular diastolic dysfunction is associated with poor functional outcomes after stroke thrombectomy.

Findings

LVDD was present in 31.4% of patients and linked to worse functional recovery at 3 months.

LVDD was not associated with increased in-hospital mortality.

Successful reperfusion was achieved in 78.9% of patients, but 57.1% had poor functional recovery.

Abstract

Introduction: With the advent of endovascular thrombectomy (ET), patients with acute ischaemic strokes (AIS) with large vessel occlusion (LVO) have seen vast improvements in treatment outcomes. Left ventricular diastolic dysfunction (LVDD) has been shown to herald poorer prognosis in conditions such as myocardial infarction. However, whether LVDD is related to functional recovery and outcomes in ischaemic stroke remains unclear. We studied LVDD for possible relation with clinical outcomes in patients with LVO AIS who underwent ET. Methods: We studied a retrospective cohort of 261 LVO AIS patients who had undergone ET at a single comprehensive stroke centre and correlated LVDD to short-term mortality (in-hospital death) as well as good functional recovery defined as modified Rankin Scale of 0–2 at 3 months. Results: The study population had a mean age of 65-years-old and were predominantly male (54.8%). All of the patients underwent ET with 206 (78.9%) achieving successful reperfusion. Despite this, 25 (9.6%) patients demised during the hospital admission and 149 (57.1%) did not have good function recovery at 3 months. LVDD was present in 82 (31.4%) patients and this finding indicated poorer outcomes in terms of functional recovery at 3 months (OR 2.18, 95% CI 1.04–4.54, p = 0.038) but was not associated with increased in-hospital mortality (OR 2.18, 95% CI 0.60–7.99, p = 0.240) after adjusting for various confounders. Conclusion: In addition to conventional echocardiographic indices such as left ventricular ejection fraction, LVDD may portend poorer outcomes after ET, and this relationship should be investigated further.

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