Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230011, Anhui, China.
Department of Neurology, Hefei Hospital Affiliated to Anhui Medical University (The Second People’s Hospital of Hefei), Hefei 230011, Anhui, China.
Aging (Albany NY). 2024 May 2;16(9):7845-7855. doi: 10.18632/aging.205786.
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.
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.
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.
Our finding indicated that AIS patients with LVSD after IVT had poorer outcomes, suggesting the need to monitor and optimize LVEF in stroke management.
尽管静脉注射重组组织型纤溶酶原激活剂（rt-PA）溶栓是急性缺血性脑卒中（AIS）最有效的早期治疗方法，但患者之间的疗效差异很大。左心室收缩功能障碍（LVSD）容易导致远处器官缺血，并且可能是接受静脉溶栓（IVT）的 AIS 患者预后不良的预测因素。我们的目的是研究 LVSD 诊断（通过左心室射血分数（LVEF）测量）对接受溶栓治疗的 AIS 患者 90 天临床结局的预测能力。
本前瞻性队列研究连续纳入了 2021 年至 2023 年期间，在全国脑卒中预防与治疗工程管理专项数据库中接受 IVT 治疗并在入院 24 小时内完成超声心动图检查的 273 名 AIS 患者。LVSD 通过评估超声心动图 Simpson 双平面法圆盘的 LVEF 值来诊断，定义为 LVEF 值<50%。多变量有序逻辑回归模型用于分析 LVEF 与 3 个月时功能结局之间的关联。受限立方样条（RCS）用于检查 LVEF 降低与不良功能结局之间的剂量-反应关系的形状。还进行了亚组分析，以进一步验证结果的可靠性和实用性。
基线数据分析显示，LVSD 患者合并症更多，包括多变量分析中的 LVSD（OR 2.78，95%CI 1.23-6.24，P=0.014）、预先存在的糖尿病（OR 2.08，95%CI 1.11-3.90，P=0.023）和入院时 NIHSS（OR 1.31，95%CI 1.21-1.49，P<0.001）是 3 个月时功能结局不良（mRS≥3）的独立预测因素。多变量调整后的样条回归表明，IVT 后 LVEF 与不良功能结局之间存在线性剂量-反应关系（p<0.001），LVEF 的最佳截断值为 0.48。
我们的发现表明，接受 IVT 后出现 LVSD 的 AIS 患者结局较差，提示在脑卒中管理中需要监测和优化 LVEF。
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