A H Katsanos1,2, A V Alexandrov3, P Mandava4,5, M Köhrmann6, L Soinne7, A D Barreto8, V K Sharma9, R Mikulik10, K W Muir11, T Rothlisberger12, J C Grotta13, C R Levi14, C A Molina15, M Saqqur16,17, L Palaiodimou2, T Psaltopoulou18, M R Vosko19, T Moreira20, J B Fiebach21, M Rubiera15, E C Sandset22, A de Havenon23, T A Kent24,25, A W Alexandrov3, P D Schellinger26, G Tsivgoulis2,3. 1. Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada. 2. Second Department of Neurology, 'Attikon' University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. 3. Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA. 4. Stroke Outcomes Laboratory, Department of Neurology, Baylor College of Medicine, Houston, TX, USA. 5. Michael E. DeBakey VA Medical Center Stroke Program and Center for Translational Research on Inflammatory Diseases, Houston, TX, USA. 6. Department of Neurology, University Hospital Essen, Essen, Germany. 7. Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland. 8. Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX, USA. 9. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and Division of Neurology, National University Hospital, Singapore, Singapore. 10. International Clinical Research Centre and Department of Neurology, St Anne's University Hospital in Brno and Medical Faculty, Masaryk University, Brno, Czech Republic. 11. Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK. 12. Cerevast Medical Inc., Bothell, WA, USA. 13. Clinical Innovation and Research Institute, Memorial Hermann Hospital-Texas Medical Center, Houston, TX, USA. 14. Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia. 15. Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain. 16. Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada. 17. Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar. 18. Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. 19. Department of Neurology 2, Med Campus III, Kepler University Hospital, Linz, Austria. 20. Department of Neurology, Karolinska University Hospital, Stockholm, Sweden. 21. Center for Stroke Research Berlin, Charité-University Medicine Berlin, Berlin, Germany. 22. Department of Neurology, Stroke Unit, Oslo University Hospital, Oslo, Norway. 23. Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA. 24. Texas A&M Health Science Center-Houston campus, University of Texas, Houston, TX, USA. 25. Department of Neurology, Houston Methodist Hospital, Houston, TX, USA. 26. Departments of Neurology and Neurogeriatry, John Wesling Medical Center Minden, Ruhr University Bochum, Minden, Germany.
Abstract
BACKGROUND AND PURPOSE: Blood pressure (BP) variability has been associated with worse neurological outcomes in acute ischaemic stroke (AIS) patients receiving treatment with intravenous thrombolysis (IVT). However, no study to date has investigated whether pulse pressure (PP) variability may be a superior indicator of the total cardiovascular risk, as measured by clinical outcomes. METHODS: Pulse pressure variability was calculated from 24-h PP measurements following tissue plasminogen activator bolus in AIS patients enrolled in the Combined Lysis of Thrombus using Ultrasound and Systemic Tissue Plasminogen Activator for Emergent Revascularization (CLOTBUST-ER) trial. The outcomes of interest were the pre-specified efficacy and safety end-points of CLOTBUST-ER. All associations were adjusted for potential confounders in multivariable regression models. RESULTS: Data from 674 participants was analyzed. PP variability was identified as the BP parameter with the most parsimonious fit in multivariable models of all outcomes, and was independently associated (P < 0.001) with lower likelihood of both 24-h neurological improvement and 90-day independent functional outcome. PP variability was also independently related to increased odds of any intracranial bleeding (P = 0.011) and 90-day mortality (P < 0.001). Every 5-mmHg increase in the 24-h PP variability was independently associated with a 36% decrease in the likelihood of 90-day independent functional outcome (adjusted odds ratio 0.64, 95% confidence interval 0.52-0.80) and a 60% increase in the odds of 90-day mortality (adjusted odds ratio 1.60, 95% confidence interval 1.23-2.07). PP variability was not associated with symptomatic intracranial bleeding at either 24 or 36 h after IVT administration. CONCLUSIONS: Increased PP variability appears to be independently associated with adverse short-term and long-term functional outcomes of AIS patients treated with IVT.
BACKGROUND AND PURPOSE: Blood pressure (BP) variability has been associated with worse neurological outcomes in acute ischaemic stroke (AIS) patients receiving treatment with intravenous thrombolysis (IVT). However, no study to date has investigated whether pulse pressure (PP) variability may be a superior indicator of the total cardiovascular risk, as measured by clinical outcomes. METHODS: Pulse pressure variability was calculated from 24-h PP measurements following tissue plasminogen activator bolus in AISpatients enrolled in the Combined Lysis of Thrombus using Ultrasound and Systemic Tissue Plasminogen Activator for Emergent Revascularization (CLOTBUST-ER) trial. The outcomes of interest were the pre-specified efficacy and safety end-points of CLOTBUST-ER. All associations were adjusted for potential confounders in multivariable regression models. RESULTS: Data from 674 participants was analyzed. PP variability was identified as the BP parameter with the most parsimonious fit in multivariable models of all outcomes, and was independently associated (P < 0.001) with lower likelihood of both 24-h neurological improvement and 90-day independent functional outcome. PP variability was also independently related to increased odds of any intracranial bleeding (P = 0.011) and 90-day mortality (P < 0.001). Every 5-mmHg increase in the 24-h PP variability was independently associated with a 36% decrease in the likelihood of 90-day independent functional outcome (adjusted odds ratio 0.64, 95% confidence interval 0.52-0.80) and a 60% increase in the odds of 90-day mortality (adjusted odds ratio 1.60, 95% confidence interval 1.23-2.07). PP variability was not associated with symptomatic intracranial bleeding at either 24 or 36 h after IVT administration. CONCLUSIONS: Increased PP variability appears to be independently associated with adverse short-term and long-term functional outcomes of AISpatients treated with IVT.
Authors: Shuiping Zhu; Bin Meng; Jianping Jiang; Xiaotao Wang; Na Luo; Ning Liu; Huaping Shen; Lu Wang; Qian Li Journal: Front Cell Neurosci Date: 2022-02-11 Impact factor: 5.505