Left ventricular ejection fraction <60 % is associated with short-term functional disability in patients of acute ischemic stroke

Guojuan Chen; Peng Ding; Liqin Yang; Xueqing Liu; Delin Yu; Wei Yue

doi:10.1016/j.heliyon.2024.e29352

Left ventricular ejection fraction <60 % is associated with short-term functional disability in patients of acute ischemic stroke

Heliyon. 2024 Apr 10;10(8):e29352. doi: 10.1016/j.heliyon.2024.e29352. eCollection 2024 Apr 30.

Authors

Guojuan Chen^{1

2}, Peng Ding¹, Liqin Yang¹, Xueqing Liu¹, Delin Yu³, Wei Yue¹

Affiliations

¹ Department of Neurology, Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin Huanhu Hospital, Tianjin, China.
² Department of Neurology, Tangshan Gongren Hospital, Tangshan, China.
³ Department of Ultrasonic, Tianjin Huanhu Hospital, Tianjin, China.

Abstract

Background and objective: The association between cardiac dysfunction and functional outcome in acute ischemic stroke (AIS) is not clear. We aimed to investigate the relationship between the routinely assessed left ventricular ejection fraction (LVEF) and functional outcomes in patients with AIS.

Methods: Data came from a prospective, observational, single-center study (Effect of Cardiac Function on Short-term Functional Prognosis in Patients with Acute Ischemic Stroke, SPARK). The LVEF was assessed with transthoracic echocardiography within 7 days of stroke onset. The primary outcome was functional disability, defined as a modified Rankin Scale score of 3-6 at 90 days (range: 0-6, with higher scores indicating greater disability). We also investigated the association of the LVEF with mortality, early neurological deterioration, hospital stay, and costs. Multivariate logistic regression analysis and 2:1 propensity score matching (PSM) were performed to compare the differences in outcomes.

Results: A total of 1181 patients were included in this analysis, of which 87 (7.4 %) patients were found to have LVEF of <60 %. In the entire study population, LVEF<60 % was significantly associated with functional disability at 90 days (odds ratio [OR]: 1.85, 95 % confidence intervals (CI): 1.01-3.40) after adjusting for all confounders. After PSM, the association was consistently significant (OR: 5.32, 95 % CI: 3.04-9.30). However, associations of the LVEF with mortality, early neurological deterioration, hospital stay, and costs were not consistently significant across all analyses. In the subgroup analysis, the association of LVEF of <60 % with functional disability was statistically significant in patients with non-cardioembolic stroke, but not in patients with cardioembolic stroke (P for interaction = 0.872).

Conclusions: An LVEF of <60 % will likely increase the risk of functional disability in patients with AIS. Future strategies to prevent cardiac dysfunction in the acute phase are needed.

Keywords: Acute ischemic stroke; Cardiac systolic dysfunction; Functional outcome; Left ventricular ejection fraction.