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Computed Tomography Perfusion Identifies Patients With Stroke With Impaired Cardiac Function.
Stroke ( IF 8.3 ) Pub Date : 2020-01-03 , DOI: 10.1161/strokeaha.119.027255
Carlos Garcia-Esperon 1, 2 , Neil J Spratt 1, 2 , Shyam Gangadharan 1 , Ferdinand Miteff 1, 2 , Andrew Bivard 3 , Thomas Lillicrap 2 , Shinya Tomari 2 , Christopher R Levi 1, 2 , Mark W Parsons 2, 3
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Background and Purpose- Low left ventricular ejection fraction (LVEF) leads to worse outcomes after stroke. We hypothesized that the arterial input function (AIF) variability on perfusion computed tomography, especially the time between scan onset and end of AIF (SO-EndAIF), would reflect reduction of cardiac output. Methods- Retrospective analysis of consecutive stroke patients, who underwent computed tomography between January 2013 and September 2018, was performed in 2 parts. (1) To determine the correlation between SO-EndAIF and LVEF, all patients with a transthoracic echocardiogram performed ±6 months from the time of stroke were included. LVEF was dichotomized as either normal (≥50%) or decreased (<50%). (2) AIF was compared with hypoperfusion volume, defined as delay time >3 seconds and with clinical outcome measured using 3-month modified Rankin Scale. Results- A total of 732 ischemic stroke patients underwent computed tomography, 231 with transthoracic echocardiogram were included in part (1), 393 with outcome data were included in part (2). In part (1), 193/231 (83.5%) had normal LVEF (median 61%) and 38/231 (16.5%) decreased LVEF (median 39%). The low-LVEF group had significantly prolonged SO-EndAIF compared with normal-LVEF group (mean of 39.7 versus 26 second; P<0.001), and larger hypoperfusion lesions (94.9 versus 37.6 mL; P<0.001). SO-EndAIF time was strongly associated with EF, with an area under the curve of 0.86. Twenty nine seconds was the best threshold to distinguish between normal and impaired EF (area under the curve, 0.77). In part (2), the SO-EndAIF ≥29 second group had larger hypoperfusion volumes (21.8 versus 89.7 mL; P<0.001) and infarct core (12.2 versus 2.3 mL; P<0.0001) and patients with SO-EndAIF ≥29 seconds had fewer excellent or good clinical outcomes (modified Rankin Scale score 0-1; 40% versus 22%; OR, 2.79; P<0.001, modified Rankin Scale score 0-2; 65% versus 35%; OR, 1.41; P=0.033). Conclusions- AIF width correlates with ejection fraction in acute ischemic stroke. A 29-second threshold from scan onset to end of AIF accurately predicts reduced LVEF and identifies patients more likely to have worse outcomes after stroke.

中文翻译:

计算机断层扫描灌注可确定患有心脏功能受损的中风患者。

背景与目的-左心室射血分数低(LVEF)导致中风后预后较差。我们假设灌注计算机断层扫描的动脉输入功能(AIF)变异性,特别是扫描开始到AIF结束之间的时间(SO-EndAIF),将反映心输出量的减少。方法-分为2部分,对2013年1月至2018年9月间接受计算机X线断层扫描的连续卒中患者进行回顾性分析。(1)为确定SO-EndAIF与LVEF之间的相关性,纳入了所有自卒中起±6个月行经胸超声心动图检查的患者。LVEF被分为正常(≥50%)或下降(<50%)。(2)将AIF与灌注不足量进行比较,定义为延迟时间> 3秒钟,并使用3个月改良兰金量表测量临床结果。结果-共有732例缺血性中风患者接受了计算机断层扫描,其中(1)包括231例经胸超声心动图,(2)包括393例具有结局数据。在第(1)部分中,193/231(83.5%)的LVEF正常(中位数61%),而38/231(16.5%)的LVEF降低(中位数39%)。与正常LVEF组相比,低LVEF组的SO-EndAIF显着延长(平均值为39.7对26秒; P <0.001),并且灌注不足损伤更大(94.9对37.6 mL; P <0.001)。SO-EndAIF时间与EF密切相关,曲线下的面积为0.86。29秒是区分正常和受损EF的最佳阈值(曲线下面积0.77)。在第(2)部分,SO-EndAIF≥29的第二组灌注不足量较大(21.8对89.7 mL; P <0.001)和梗塞核心(12.2对2.3 mL; P <0.0001),SO-EndAIF≥29秒的患者优良或良好的临床表现较少结果(改良兰金量表评分0-1; 40%对22%; OR,2.79; P <0.001,改良兰金量表评分0-2; 65%对35%; OR 1.41; P = 0.033)。结论:急性缺血性卒中的AIF宽度与射血分数相关。从扫描开始到AIF结束的29秒阈值可准确预测LVEF降低,并确定中风后更有可能出现较差结果的患者。0.001,改良Rankin量表评分0-2;65%对35%; 或1.41;P = 0.033)。结论:急性缺血性卒中的AIF宽度与射血分数相关。从扫描开始到AIF结束的29秒阈值可准确预测LVEF降低,并确定中风后更有可能出现较差结果的患者。0.001,改良Rankin量表评分0-2;65%对35%; 或1.41;P = 0.033)。结论:急性缺血性卒中的AIF宽度与射血分数相关。从扫描开始到AIF结束的29秒阈值可准确预测LVEF降低,并确定中风后更有可能出现较差结果的患者。
更新日期:2020-01-29
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