Li Tony Y W, Toh Emma M S, Koh Ying Ying, Leow Aloysius S T, Chan Bernard P L, Teoh Hock-Luen, Seet Raymond C S, Gopinathan Anil, Yang Cunli, Sharma Vijay K, Yeo Leonard L L, Chan Mark Y, Kong William K F, Poh Kian-Keong, Tan Benjamin Y Q, Sia Ching-Hui
Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore 119228, Singapore.
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
J Cardiovasc Dev Dis. 2024 Mar 5;11(3):87. doi: 10.3390/jcdd11030087.
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.
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.
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, = 0.038) but was not associated with increased in-hospital mortality (OR 2.18, 95% CI 0.60-7.99, = 0.240) after adjusting for various confounders.
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.
随着血管内血栓切除术（ET）的出现，患有大血管闭塞（LVO）的急性缺血性卒中（AIS）患者的治疗结果有了显著改善。左心室舒张功能障碍（LVDD）已被证明在心肌梗死等疾病中预示着较差的预后。然而，LVDD是否与缺血性卒中的功能恢复和预后相关仍不清楚。我们研究了LVDD与接受ET治疗的LVO AIS患者临床结局之间的可能关系。
我们研究了一个回顾性队列，其中261例LVO AIS患者在一个综合性卒中中心接受了ET治疗，并将LVDD与短期死亡率（住院死亡）以及3个月时改良Rankin量表评分为0 - 2定义的良好功能恢复情况进行关联分析。
研究人群的平均年龄为65岁，男性占主导（54.8%）。所有患者均接受了ET治疗，其中206例（78.9%）实现了成功再灌注。尽管如此，25例（9.6%）患者在住院期间死亡，149例（57.1%）患者在3个月时未实现良好的功能恢复。82例（31.4%）患者存在LVDD，这一发现表明在3个月时功能恢复方面结局较差（比值比2.18，95%置信区间1.04 - 4.54，P = 0.038），但在调整各种混杂因素后，与住院死亡率增加无关（比值比2.18，95%置信区间0.60 - 7.99，P = 0.240）。
除了传统的超声心动图指标如左心室射血分数外，LVDD可能预示着ET治疗后较差的结局，这种关系应进一步研究。
