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Ischemic stroke risk during post-discharge phases of heart failure: association of left ventricular concentric
Yasuhiro Shintani1, Hiroyuki Takahama2, Yasuhiro Hamatani1
1Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, 564-8565, Japan.
Insights
Heart failure patients face a significant risk of post-discharge ischemic stroke, even with standard treatments. Left ventricular concentric geometry, indicated by relative wall thickness, is a key risk factor, especially for those with atrial fibrillation.
Area of Science:
- Cardiology
- Neurology
- Clinical Medicine
Background:
- Hospitalized acute heart failure (HF) patients have a known risk of ischemic stroke (IS).
- Limited data exists on IS risk during the post-discharge period for HF patients.
- Standard HF treatments may not fully mitigate post-discharge IS risk.
Purpose of the Study:
- To determine the IS incidence rate in post-discharge HF patients on standard treatment.
- To investigate the association between IS incidence and clinical factors, including cardiac structure and function.
- To identify specific cardiac geometric patterns that predict IS risk in HF patients.
Main Methods:
- Retrospective analysis of 950 hospitalized HF patients over a 2-year post-discharge period.
- Echocardiographic assessment of relative wall thickness (RWT) and left ventricular (LV) mass to define LV geometric patterns.
- Multivariate analysis to evaluate associations between clinical data and IS occurrence.
Main Results:
- IS occurred in 2.6% of patients post-discharge (1.4 per 100 patient-years).
- IS incidence was higher in patients with atrial fibrillation (AF) (1.8 vs. 1.0 per 100 patient-years).
- Increased RWT, indicating LV concentric geometry, was significantly associated with higher IS risk (p<0.05), particularly in patients with AF or left atrial enlargement.
Conclusions:
- HF patients remain at high risk for IS after hospital discharge, despite standard treatments.
- LV concentric geometry, characterized by increased RWT, is an independent risk factor for post-discharge IS.
- RWT is a crucial predictor of IS in HF patients with left atrial remodeling and/or AF.
Abstract:
Despite a higher risk of ischemic stroke in hospitalized patients with acute heart failure (HF), little is known about the risk of ischemic stroke during the post-discharge phases of HF. Here we investigated (1) the ischemic stroke incidence rate during the post-discharge phases among HF patients receiving standard treatments; (2) the association between ischemic stroke incidence and clinical background, including cardiac structure and function. Among 950 patients who required hospitalization for HF (median duration: 19 days) at our institution, where they received standard treatments, we investigated stroke occurrences during the 2-year period following their discharge and retrospectively evaluated their clinical data. Relative wall thickness (RWT) and left ventricular (LV) mass were determined based on echocardiographic measurements and then used to determine LV geometric patterns. During the follow-up period, ischemic stroke occurred in 25 patients (2.6%) after hospital discharge (1.4 per 100 patient-years). The incidence rate of IS tended to be higher in patients with AF than those without AF (1.8 vs. 1.0 per 100 patient-years, respectively). Notably, multivariate analysis revealed a significant association between RWT and ischemic stroke risk (p < 0.05). RWT was associated with ischemic stroke risk in patients with AF or left atrial enlargement, but not in patients without them. These findings suggest that even with standard HF treatments, the risk of ischemic stroke is high in patients with HF. Moreover, LV concentric geometry is a significant risk factor for ischemic stroke in patients with HF, especially in those with left atrial remodeling and/or AF.
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