左室收缩功能障碍与6~24 h内接受机械取栓的急性缺血性脑卒中患者不良预后相关  

Left ventricular systolic dysfunction is associated with poor clinical outcomes in acute ischemic stroke patients treated with endovascular thrombectomy between 6-24 h

作　　者：吴艺 曹月洲[1] 贾振宇[1] 赵林波[1] 刘圣[1] 施海彬[1] Wu Yi;Cao Yuezhou;Jia Zhenyu;Zhao Linbo;Liu Sheng;Shi Haibin(Department of Interventional Radiology,the First Affiliated Hospital of Nanjing Medical University,Jiangsu Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院介入放射科,江苏南京210029

出　　处：《中华介入放射学电子杂志》2022年第1期16-21,共6页Chinese Journal of Interventional Radiology：electronic edition

摘　　要：目的探讨以左室射血分数(LVEF)测量的左室收缩功能障碍(LVSD)与6~24 h内接受机械取栓治疗的前循环大血管闭塞型急性缺血性脑卒中(AIS)患者90 d预后的相关性。方法回顾性分析2018年1月至2021年1月在发病后6~24 h内于我院接受机械取栓治疗的急性缺血性脑卒中患者资料。根据国际准则采用Simpson双平面法在二维超声心动图上评估LVEF,LVEF<50%即定义为LVSD。90 d改良Rankin量表(mRS)评分3~6分定义为不良功能预后。采用单因素和多因素Logistic回归分析明确LVSD与90 d不良预后的相关性。结果共计纳入了107例患者,其中26例(24.3%)术后出现了LVSD。多因素分析显示,LVSD(OR=4.206,95%CI:1.357~13.035,P=0.013)、美国国立卫生研究院卒中量表(NIHSS)基线评分高(OR=1.234,95%CI:1.114~1.367,P<0.001)、再灌注不良(m TICI 0~2a)(OR=4.388,95%CI:1.373~14.023,P=0.013)是90 d不良功能预后的独立危险因素。年龄(OR=1.081,95%CI:1.005~1.161,P=0.035)、LVSD(OR=3.783,95%CI:1.029~13.911,P=0.045)、美国国立卫生研究院卒中量表(NIHSS)基线评分高(OR=1.109,95%CI:1.026~1.198,P=0.009)是90 d死亡率的独立危险因素。结论LVSD与6~24 h接受机械取栓治疗的急性缺血性脑卒中患者90 d不良预后独立相关。Objective To evaluate the association between left ventricular systolic dysfunction(LVSD)measured by left ventricular ejection fraction(LVEF)and 90 d clinical outcomes in acute ischemic stroke(AIS)patients with large vessel occlusion(LVO)in the anterior cerebral circulation who underwent endovascular thrombectomy(EVT)between 6-24 h.Methods The clinical data of AIS patients with LVO in the anterior cerebral circulation who underwent EVT between 6-24 h after symptom onset in our hospita from January 2018 to January 2021 were retrospectively analyzed.LVEF was measured on two-dimensional echocardiography using Simpson’s biplane method of discs according to international guidelines.LVSD was defined as LVEF<50%.A modified Rankin Scale(mRS)of 3-6 at 90 d was defined as a poor functional outcome.The univariate and multivariate logistic regression analyses were used to access the correlation between LVSD and 90 d poor clinical outcome.Results A total of 107 patients were enrolled in this study,of whom 26(24.3%)patients had LVSD.On multivariate analyses,LVSD(OR=4.206,95%CI:1.357-13.035,P=0.013),baseline high National Institutes of Health Stroke Scale(NIHSS)score(OR=1.234,95%CI:1.114-1.367,P<0.001)and poor reperfusion(mTICI 0-2 a)(OR=4.388,95%CI:1.373-14.023,P=0.013)were independent predictors of 90 d poor functional outcomes.Age(OR=1.081,95%CI:1.005-1.161,P=0.035),LVSD(OR=3.783,95%CI:1.029-13.911,P=0.045),and baseline high National Institutes of Health Stroke Scale(NIHSS)score(OR=1.109,95%CI:1.026-1.198,P=0.009)were independent risk factors for 90 d mortality.Conclusions LVSD was independently associated with 90 d poorer outcomes in AIS patients with LVO in the anterior circulation who underwent EVT between 6-24 h.

关 键 词：急性缺血性脑卒中 左室收缩功能障碍 左室射血分数 机械取栓 临床预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]