Effect of Left Ventricular Systolic Dysfunction on the Outcome of Mechanical Thrombectomy

Abstract

Objective: Left ventricular systolic dysfunction has traditionally been considered an unfavorable prognostic factor in stroke. However, chronic hypoperfusion due to this dysfunction may improve cerebral collateral flow, potentially serving as a compensatory mechanism during ischemic stroke. This study aimed to investigate the effects of left ventricular systolic dysfunction on outcomes after mechanical thrombectomy (MT), with a focus on cerebral collateral flow.

Methods: This retrospective cohort study included 94 consecutive patients with acute ischemic stroke who underwent MT between April 2017 and July 2022. Patients were divided into 2 groups based on their left ventricular ejection fraction (EF): the reduced EF group (EF ≤40%) and the preserved EF group (EF >40%). We evaluated post-treatment stroke volume, clinical outcomes, length of hospital stay, and the relationship between EF and cerebral collateral flow.

Results: The reduced and preserved EF groups consisted of 11 (12%) and 83 (88%) patients, respectively. No significant differences were observed in post-treatment stroke volume (13 vs. 12 cm³, p = 0.779), hospital stay duration (23 vs. 22 days, p = 0.634), or favorable clinical outcomes at discharge (36% vs. 43%, p = 0.754) between the 2 groups. The odds ratio for favorable outcomes at discharge, adjusted using inverse probability of treatment weighting, was 0.693 (95% confidence interval: 0.176–2.732, p = 0.600) for the reduced EF group compared with the preserved EF group. Cerebral collateral flow developed better in the reduced EF group (56% vs. 13%, p = 0.008).

Conclusion: Left ventricular systolic dysfunction did not significantly worsen outcomes after MT. Chronic cerebral hypoperfusion due to left ventricular systolic dysfunction may promote the development of cerebral collaterals, potentially enhancing resistance to ischemic events.