Estimated Pulse Wave Velocity Predicts Outcomes After Acute Ischemic Stroke: A Multinational Cohort Analysis
Nikolaos Kakaletsis, Naohisa Hosomi, Tomohisa Nezu, Patrik Michel, Thevoz Guillaume, Davide Strambo, Young Seo Kim, Wonjae Sung, Konstantinos Vemmos, Eleni Korompoki, Maurizio Acampa, Jukka Putaala, Lauri Tulkki, Matthias Hermann, Protazy Rejmer, Philip M Bath, Lisa J Woodhouse, Vasilios Kotsis, Elpida Athanasopoulou, Athanase D Protogerou, Haralampos Milionis, George Ntaios, Christos SavopoulosAbstract
Background
Estimated pulse wave velocity (ePWV), an easy to calculate proxy of carotid to femoral PWV (cfPWV), can be derived from 24-hour blood pressure monitoring (24h-BPM). Its role in acute ischemic stroke (AIS) has not previously been investigated in large multinational datasets.
Methods
A pooled individual patient data analysis from 13 cohorts across seven countries was conducted, including 2,933 AIS patients who underwent 24h-BPM during the hyperacute to subacute phase. ePWV was calculated using a validated equation. Associations with clinical characteristics, stroke severity, etiologic subtypes, and outcomes were assessed with logistic regression. The primary outcome was poor functional outcome at 90 days, defined as a modified Rankin Scale (mRS) >2.
Results
Patients with higher ePWV presented with more severe strokes (median NIHSS 7 vs. 3, P < .001) and had poorer outcomes both at 90 days (63.7% vs. 23.7%, P < .001) and discharge (61.9% vs 29.1%, P < .001). ePWV was associated with poor outcome at 90 days (aOR: 1.24, 95% CI: 1.05-1.45) and discharge (aOR: 1.26, 95% CI: 1.12-1.42), per 1 m/s increase in ePWV, after adjustment for conventional risk factors and stroke severity. In patients ≤50 years, ePWV was highest in those with small vessel disease (SVD), who also had more cardiovascular risk factors than other stroke subtypes.
Conclusions
ePWV derived from 24h-BPM is a simple, widely applicable measure of vascular aging that is associated with functional outcome after AIS. The higher ePWV observed in young patients with SVD underscores a potential early arteriosclerotic burden in this subgroup.