Risk assessment of acute heart failure after endovascular therapy in acute ischemic stroke: a nomogram-based study

Abstract

Background Acute heart failure (AHF) is a life-threatening complication following endovascular therapy (EVT) for acute ischemic stroke with large vessel occlusion (AIS-LVO). This study aims to identify independent predictors of AHF after EVT and to develop and validate a nomogram for individualized risk prediction. Methods We retrospectively enrolled data from patients with acute ischemic stroke with large vessel occlusion who underwent endovascular treatment between September 2021 and June 2025 were analysed in October 2025. After screening based on inclusion and exclusion criteria, 457 patients were randomly allocated into training (n = 320) and validation (n = 137) cohorts in a 7:3 ratio. Least absolute shrinkage and selection operator (LASSO) regression was used for feature selection, followed by multivariate logistic regression to identify independent predictors of AHF. A nomogram was constructed accordingly. The model's performance was assessed using the area under the receiver operating characteristic curve (AUC), calibration plots, decision curve analysis (DCA), and clinical impact curves (CIC). Results Multivariate analysis identified five independent predictors of AHF after EVT: atrial fibrillation, valvular heart disease, left ventricular ejection fraction, serum creatinine, and troponin T. The nomogram demonstrated excellent discriminative ability, with an AUC of 0.909 (95% CI: 0.837–0.980) in the validation cohort. Calibration curves indicated good agreement between predicted and observed risks. DCA and CIC confirmed the model's favorable clinical net benefit. Conclusion We developed and validated a five-factor nomogram that effectively predicts the individualized risk of AHF following EVT in patients with AIS-LVO.