Lei Liu,1,2 Chunyan Jia,1 Chengfeng Xing,1,2 Xinyi Fu,1,2 Zhen Liu,3 Aijun Ma1 

1Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, People’s Republic of China; 2School of Neurology, Qingdao University, Qingdao, 266071, People’s Republic of China; 3Department of Endocrinology, Jimo People’s Hospital, Qingdao, 266200, People’s Republic of China

Correspondence: Aijun Ma, Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, People’s Republic of China, Tel +86 13687656836, Email drmaj@126.com

Purpose: Hemorrhagic transformation (HT) is a severe complication in patients with acute ischemic stroke (AIS) undergoing intravenous thrombolysis therapy (IVT). Epicardial adipose tissue (EAT) contributes to the development of AIS and the disruption of the blood-brain barrier. This study aims to investigate the relationship between EAT and the risk of HT, as well as functional outcomes, in AIS patients treated with IVT.
Patients and Methods: 230 AIS patients were included. Epicardial adipose tissue volume (EATV) and EAT attenuation were measured from chest CT scans. Follow-up cranial CT or magnetic resonance imaging (MRI) assessed HT occurrence. Patients were stratified into groups based on the presence of HT or parenchymal hematoma (PH), and their 90-day functional outcomes (evaluated by the modified Rankin Scale).
Results: HT occurred in 52 (22.61%) patients, including 28 (12.17%) patients with PH, 85 (37.00%) patients had poor 90-day functional prognosis. Compared to the first quartile of EATV, the third quartile (OR 9.254, 95% CI 1.533– 55.853) and the fourth quartile (OR 11.117, 95% CI 1.925– 64.211) of EATV were independent predictors of HT; and EATV as a continuous variable (OR 1.022, 95% CI 1.005– 1.040) was an independent risk factor for PH. Higher EAT attenuation was independently associated with poor prognosis (OR 1.170, 95% CI 1.056– 1.297). The area under curve for predicting HT, PH and 90-day poor functional outcome was 0.705 (95% CI 0.632– 0.778), 0.693 (95% CI 0.597– 0.789), and 0.720 (95% CI 0.653– 0.787).
Conclusion: The study demonstrates that EAT is associated with HT and poor 90-day outcomes in AIS patients undergoing IVT.

Keywords: epicardial adipose tissue, inflammation, hemorrhagic transformation, ischemic stroke, intravenous thrombolysis, early neurological deterioration