Abstract TP47: Mitral Regurgitation Might Prevent the Neurological Recovery After Endovascular Thrombectomy in Patients With Atrial Fibrillation

Abstract

Hypothesis: Some of hyperacute stroke patients had unfavorable outcome even when the occlusive artery was successfully opened. We hypothesized that moderate-to-sever mitral regurgitation (significant MR) might inhibit cerebral reperfusion, and thus decrease the rate of good clinical outcome after endovascular thrombectomy (EVT) in patients with atrial fibrillation (AF). Method: From our prospective EVT registry, patients received transthoracic echocardiography (TTE), were retrospectively analyzed. Only patients with AF were included. Based on the presence of the moderate-to-sever MR, all patient were divided into group with and without significant MR (MR group, and non-MR group). Clinical background, laboratory findings, and TTE parameters were compared between the 2 groups. Favorable outcome was defined as mRS 0-1 at 3 months. Result: From 2014 September to 2018 December, 316 patients treated with EVT, and 246 received TTE. Among them, data on 127 patients with AF were analyzed. TTE found 25 (20%) patients had significant MR. Patients in MR group were older (p=0.05) and had higher plasma level of brain natriuretic peptide (p=0.05). NIHSS, DWI-APSECTS, TICI ≥2b reperfusion, onset-to-reperfusion time, ICA occlusion (p=0.96, 0.26, 0.52, 0.33, and 0.80) were similar between the 2 groups. Regarding TTE parameters, although ejection fraction was similar (p=0.28), left atrial area (p=0.02), right atrial area (p<0.01), and tricuspid regurgitation area (p<0.01) were elevated in the MR group. At 3 months, favorable outcome was seen in only 9% in the MR group, while 26% had it in the non-MR group (p=0.04), Group with favorable outcome had higher rate of TICI ≥2b reperfusion (p=0.04), lower NIHSS score (p=0.04), however, above mentioned TTE parameter except significant MR, were not associated favorable outcome. When we conduct multivariate regression analysis, moderate-to-sever MR the negative independent parameter of favorable outcome (odds ratio 0.17, 95%CI [0.03-0.89], p=0.04). Conclusion: The presence significant MR was related to the unfavorable outcome independent of the neurological symptom and reperfusion status on cerebral angiography.MR might prevent the clinical recovery in patients with atrial fibrillation.