Relationships Between Cardiac Function And Intracranial And Extracranial Arterial Stenosis In Large Artery Atherosclerotic Stroke

Objective:To compare the clinical manifestations and cardiac function differences between aortic arch atherosclerotic stroke and intracranial and extracranial atherosclerotic stroke.To investigate the correlation between intracranial and extracranial arterial stenosis and cardiac function in large artery atherosclerotic stroke,and the effect of cardiac function on prognosis of large artery atherosclerotic stroke.Methods:In this retrospective cohort study,patients with first-ever ischemic stroke admitted to Kunming General Hospital of People’s Liberation Army from January 2014 to October 2017 were enrolled.Clinical data were collected using standardized data extraction form,including gender,age,risk factors,examination results of intracranial and extracranial arterial,parameters of transthoracic echocardiography(left ventricular ejection fraction,left ventricle end diastolic volume,left ventricle end sytolic volume,stroke volume,left ventricular fractional shortening,cardiac output,cardiac index,mitral E peak,mitral A peak and E/A value),the OCSP and etiological classification of stroke,neurological deficit on admission and discharge,disability and survival at the end of follow-up.The multivariate logistic regression analysis was used to determine the effect of cardiac function on 30-day disability,and the results were expressed as OR(95%confidence interval,CI).The multivariate cox regression analysis was used to explore the effect of cardiac function on 30-day death,and the results were expressed as HR(95%CI).The receiver operator characteristic curve was used to analyze the predictive value of cardiac function on 30-day outcome,and the area under the curve,Youden’s index,sensitivity and specificity were calculated.Results:(1)A total of 552 subjects were finally included in this study.Among which 45(8.2%)were diagnosed to aortic arch atherosclerotic stroke and 507(91.8%)were diagnosed to intracranial and extracranial atherosclerotic stroke.There was no statistical differences in age,gender,hypertension,diabetes,hyperlipidemia,coronary atherosclerotic heart disease,hyperhomocysteinemia,smoking,drinking and OCSP classification between the two groups(P>0.05).No statistical differences in neurological deficit on admission and discharge between the two groups were found(P>0.05).In patients with aortic arch atherosclerotic stroke,hyperuricemia was more common than patients with intracranial and extracranial atherosclerotic stroke(42.2%vs.26%,P=0.04).(2)There was no statistical differences in EDV,SV,CO,CI,E peak,A peak,E/A value between the aortic arch atherosclerotic stroke group and the intracranial and extracranial atherosclerotic stroke group(P>0.05).Compared to patients with intracranial and extracranial atherosclerotic stroke,patients with aortic arch atherosclerotic stroke had lower LVEF(55.14±9.41 vs.62.99±10.44,P<0.001),and FS(median 28.00 vs.35.00,P<0.001),and higher ESV(median 45.00 vs.36.00,P=0.001).(3)Multiple linear regression analysis revealed the degree of right intracranial arterial stenosis was negatively correlated with SV(B=-0.9,P=0.002),and the degree of right extracranial arterial stenosis was negatively correlated with SV(B=-0.36,P=0.03).(4)Multivariate logistic regression analysis showed that the increase of SV reduce the risk of 30-day disability(OR=0.97,95%CI:0.95-0.99),and coronary atherosclerotic heart disease increase the risk of 30-day disability(OR=2.06,95%CI:1.05-4.06).(5)Multivariate cox regression analysis determined that the increase of CO(HR=1.58,95%CI:1.17-2.14),age(HR=1.10,95%CI:1.02-1.19)and hyperuricemia(HR=5.41,95%Cl:1.27-23.15)increase the risk of 30-day death.(6)ROC curve analysis found moderate predictive accuracy of EDV(AUC=0.73,95%CI:0.57-0.89),SV(AUC=0.71,95%CI:0.58-0.84),CO(AUC=0.81,95%CI:0.70-0.93),CI(AUC=0.72,95%CI:0.57-0.87),A peak(AUC=0.72,95%CI:0.57-0.87)for the death of large artery atherosclerotic stroke.The area under curve of CO was the largest,when the best cutoff value of CO was 6.27 L/min,the Youden’s index was 0.59,with a sensitivity of 75%and a specificity of 84%to best predict death of large artery atherosclerotic stroke.Conclusions:(1)In patients with aortic arch atherosclerotic stroke,hyperuricemia was more commonly seen than in patients with intracranial and extracranial atherosclerotic stroke.(2)Compared to patients with intracranial and extracranial atherosclerotic stroke,patients with aortic arch atherosclerotic stroke had lower LVEF,FS,and higher ESV.The cardiac systolic function of patients with aortic arch atherosclerotic stroke were worse.(3)The degree of right intracranial and extracranial arterial stenosis and SV showed negative correlation.(4)The increase of SV reduce the risk of 30-day disability in patients with large artery atherosclerotic stroke.Coronary atherosclerotic heart disease was an independent predictor of 30-day disability in patients with large artery atherosclerotic stroke.(5)The increase of CO increase the risk of 30-day death in patients with large artery atherosclerotic stroke.Age and hyperuricemia were independent predictors of 30-day death in patients with large artery atherosclerotic stroke.(6)Evaluating CO by echocardiography may predict death of large artery atherosclerotic stroke.