Pulse pressure variability is associated with unfavorable
outcomes in acute ischaemic stroke patients treated with
intravenous thrombolysis

J 2020

Pulse pressure variability is associated with unfavorable outcomes in acute ischaemic stroke patients treated with intravenous thrombolysis

KATSANOS, A. H., A. V. ALEXANDROV, P. MANDAVA, M. KOHRMANN, L. SOINNE et. al.

Basic information

Original name

Pulse pressure variability is associated with unfavorable outcomes in acute ischaemic stroke patients treated with intravenous thrombolysis

Authors

KATSANOS, A. H. (124 Canada), A. V. ALEXANDROV (840 United States of America), P. MANDAVA (840 United States of America), M. KOHRMANN (276 Germany), L. SOINNE (246 Finland), A. D. BARRETO (840 United States of America), V. K. SHARMA (702 Singapore), Robert MIKULÍK (203 Czech Republic, belonging to the institution), K. W. MUIR (826 United Kingdom of Great Britain and Northern Ireland), T. ROTHLISBERGER (840 United States of America), J. C. GROTTA (840 United States of America), C. R. LEVI (36 Australia), C. A. MOLINA (724 Spain), M. SAQQUR (124 Canada), L. PALAIODIMOU (300 Greece), T. PSALTOPOULOU (300 Greece), M. R. VOSKO (40 Austria), T. MOREIRA (752 Sweden), J. B. FIEBACH (276 Germany), M. RUBIERA (724 Spain), E. C. SANDSET (578 Norway), A. DE HAVENON (840 United States of America), T. A. KENT (840 United States of America), A. W. ALEXANDROV (840 United States of America), P. D. SCHELLINGER (276 Germany) and G. TSIVGOULIS (300 Greece, guarantor)

Edition

European Journal of Neurology, Oxford, Rapid Science Ltd. 2020, 1351-5101

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30103 Neurosciences

Country of publisher

United States of America

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 6.089

RIV identification code

RIV/00216224:14110/20:00116375

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1111/ene.14447

UT WoS

000559990700001

Keywords in English

blood pressure; intracranial hemorrhage; outcome; pulse pressure; sonothrombolysis; stroke; thrombolysis; variability

Abstract

V originále

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.

Citovat

KATSANOS, A. H., A. V. ALEXANDROV, P. MANDAVA, M. KOHRMANN, L. SOINNE, A. D. BARRETO, V. K. SHARMA, Robert MIKULÍK, K. W. MUIR, T. ROTHLISBERGER, J. C. GROTTA, C. R. LEVI, C. A. MOLINA, M. SAQQUR, L. PALAIODIMOU, T. PSALTOPOULOU, M. R. VOSKO, T. MOREIRA, J. B. FIEBACH, M. RUBIERA, E. C. SANDSET, A. DE HAVENON, T. A. KENT, A. W. ALEXANDROV, P. D. SCHELLINGER and G. TSIVGOULIS. Pulse pressure variability is associated with unfavorable outcomes in acute ischaemic stroke patients treated with intravenous thrombolysis. European Journal of Neurology. Oxford: Rapid Science Ltd., 2020, vol. 27, No 12, p. 2453-2462. ISSN 1351-5101. Available from: https://dx.doi.org/10.1111/ene.14447.

@article{1677981,
   author = {Katsanos, A. H. and Alexandrov, A. V. and Mandava, P. and Kohrmann, M. and Soinne, L. and Barreto, A. D. and Sharma, V. K. and Mikulík, Robert and Muir, K. W. and Rothlisberger, T. and Grotta, J. C. and Levi, C. R. and Molina, C. A. and Saqqur, M. and Palaiodimou, L. and Psaltopoulou, T. and Vosko, M. R. and Moreira, T. and Fiebach, J. B. and Rubiera, M. and Sandset, E. C. and de Havenon, A. and Kent, T. A. and Alexandrov, A. W. and Schellinger, P. D. and Tsivgoulis, G.},
   article_location = {Oxford},
   article_number = {12},
   doi = {http://dx.doi.org/10.1111/ene.14447},
   keywords = {blood pressure; intracranial hemorrhage; outcome; pulse pressure; sonothrombolysis; stroke; thrombolysis; variability},
   language = {eng},
   issn = {1351-5101},
   journal = {European Journal of Neurology},
   title = {Pulse pressure variability is associated with unfavorable outcomes in acute ischaemic stroke patients treated with intravenous thrombolysis},
   url = {https://onlinelibrary.wiley.com/doi/full/10.1111/ene.14447},
   volume = {27},
   year = {2020}
}

TY  - JOUR
ID  - 1677981
AU  - Katsanos, A. H. - Alexandrov, A. V. - Mandava, P. - Kohrmann, M. - Soinne, L. - Barreto, A. D. - Sharma, V. K. - Mikulík, Robert - Muir, K. W. - Rothlisberger, T. - Grotta, J. C. - Levi, C. R. - Molina, C. A. - Saqqur, M. - Palaiodimou, L. - Psaltopoulou, T. - Vosko, M. R. - Moreira, T. - Fiebach, J. B. - Rubiera, M. - Sandset, E. C. - de Havenon, A. - Kent, T. A. - Alexandrov, A. W. - Schellinger, P. D. - Tsivgoulis, G.
PY  - 2020
TI  - Pulse pressure variability is associated with unfavorable outcomes in acute ischaemic stroke patients treated with intravenous thrombolysis
JF  - European Journal of Neurology
VL  - 27
IS  - 12
SP  - 2453-2462
EP  - 2453-2462
PB  - Rapid Science Ltd.
SN  - 13515101
KW  - blood pressure
KW  - intracranial hemorrhage
KW  - outcome
KW  - pulse pressure
KW  - sonothrombolysis
KW  - stroke
KW  - thrombolysis
KW  - variability
UR  - https://onlinelibrary.wiley.com/doi/full/10.1111/ene.14447
L2  - https://onlinelibrary.wiley.com/doi/full/10.1111/ene.14447
N2  - 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.
ER  -

KATSANOS, A. H., A. V. ALEXANDROV, P. MANDAVA, M. KOHRMANN, L. SOINNE, A. D. BARRETO, V. K. SHARMA, Robert MIKULÍK, K. W. MUIR, T. ROTHLISBERGER, J. C. GROTTA, C. R. LEVI, C. A. MOLINA, M. SAQQUR, L. PALAIODIMOU, T. PSALTOPOULOU, M. R. VOSKO, T. MOREIRA, J. B. FIEBACH, M. RUBIERA, E. C. SANDSET, A. DE HAVENON, T. A. KENT, A. W. ALEXANDROV, P. D. SCHELLINGER and G. TSIVGOULIS. Pulse pressure variability is associated with unfavorable outcomes in acute ischaemic stroke patients treated with intravenous thrombolysis. \textit{European Journal of Neurology}. Oxford: Rapid Science Ltd., 2020, vol.~27, No~12, p.~2453-2462. ISSN~1351-5101. Available from: https://dx.doi.org/10.1111/ene.14447.

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