Left ventricular ejection fraction and aortic stiffness are independent predictors of neurological outcome in acute ischemic stroke

Abstract

Stroke is a leading cause of disability and one of the major causes of death worldwide. The short-term prognosis in individual patients is highly variable and cannot be explained solely by stroke severity. We investigated the association of left ventricular ejection fraction with early neurological outcome in acute ischemic stroke. In total, 216 patients enrolled in a prospective study, underwent echocardiography and applanation tonometry performed within 1 week after stroke onset. At day 10, favorable outcome was defined as a 4 or more point improvement from baseline National Institutes of Health Stroke Scale or final National Institutes of Health Stroke Scale of 0-1. In patients with favorable outcome, the ejection fraction was significantly higher comparing with patients with poorer prognosis (54.3 ± 7.9 vs. 49.9 ± 9.8%, P = 0.005). Favorable neurological outcome at day 10 was also associated with lower heart rate and lower pulse wave velocity at baseline. Univariate analyses showed that left ventricle ejection fraction and arterial stiffness were the strongest predictors of the poststroke improvement. In multivariate analysis, ejection fraction at least 50% remained significantly associated with favorable outcome after full adjustment for potential confounders (odds ratio 3.81, [95% confidence interval, 1.18-12.35]; P = 0.02). These findings provide evidence that in ischemic stroke, preserved ejection fraction and lower pulse wave velocity are associated with early favorable outcome, independently of other known prognostic factors, including blood pressure.