The Correlation between Severity of Neurological Impairment and Left Ventricular Function in Patients after Acute Ischemic Stroke.

Pei-Hsun Sung,Hung-Sheng Lin,Chi-Hsiang Chu,Hon-Kan Yip,Kuan-Hung Chen,John Chiang

doi:10.3390/jcm8020190

Abstract

Despite left ventricular (LV) dysfunction increases the risk of incidental acute ischemic stroke (AIS), the association between LV function and severity of neurological deficits after AIS remains unclear. Between November 2015 and October 1017, a total of 99 AIS patients were prospectively enrolled and categorized into two groups based on National Institute of Health Stroke Scale (NIHSS). The AIS patients with NIHSS <6 were allocated into Group 1 (n = 50) and those with NIHSS ≥6 were into Group 2 (n = 49). Echocardiography was performed within 5 days after AIS to assess chamber size, left ventricular ejection fraction (LVEF) and valvular regurgitation. Besides, two inflammatory biomarkers, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), were evaluated on admission. The results showed Group 2 had significantly higher value of NLR and PLR (all p-values < 0.01) but lower LVEF (p = 0.001) and frequency of mitral regurgitation (p = 0.021) than Group 1. The NIHSS and modified Rankin scale were significantly negatively correlated with LVEF, whereas both were significantly positively correlated with NLR and PLR (all p-values < 0.02). Multivariate analysis showed LVEF <65%, aging and inflammation were significantly associated with NIHSS ≥6 (all p-values < 0.01). In conclusion, the AIS patients with NIHSS ≥6 had lower LVEF but more clinically dominant mitral regurgitation and higher NLR and PLR compared to those with NIHSS <6.

Highlights

Acute ischemic stroke (AIS) is a severe disabling cerebrovascular event [1] and has a great impact on patient’s life and socioeconomic burden [2]
The baseline variables demonstrated that there were no significant differences between Group 1 and Group 2 in terms of systolic and diastolic blood pressure and incidences of gender, hypertension, diabetes mellitus, old stroke, old myocardial infarction and utilization of ACEI or ARB
The laboratory findings showed that the leukocyte and platelet counts, hemoglobin and percentage of neutrophils did not differ between these two groups of the patients

Summary

Introduction

Acute ischemic stroke (AIS) is a severe disabling cerebrovascular event [1] and has a great impact on patient’s life and socioeconomic burden [2]. Data from our previous study [17] has demonstrated that the NT-proBNP, a useful biomarker for predictive of acute decompensated heart failure, is significantly increased in patients after AIS and an independent predictor for unfavorable neurological outcomes. These findings [13,14,15,16] raise the hypothesis that there may be a strongly negative correlation between the neurological functional status and the left ventricular ejection fraction (LVEF) in patients after AIS.

Methods

Results

Conclusion