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Incidence and predictors of stroke in patients with rheumatic heart disease
Marcelle Vasconcelos1, Luiz Vasconcelos1, Victor Ribeiro2
1Post Graduation Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Insights
Ischaemic stroke is a serious risk for patients with rheumatic heart disease (RHD). Prior stroke, age, and atrial fibrillation (AF) predict stroke, though AF
Area of Science:
- Cardiology
- Neurology
- Epidemiology
Background:
- Rheumatic heart disease (RHD) is a significant cause of ischaemic stroke, leading to disability and mortality.
- Understanding stroke incidence and predictors in RHD patients is crucial for effective prevention strategies.
Purpose of the Study:
- To determine the incidence of ischaemic stroke in patients with RHD.
- To identify predictors of stroke in RHD patients within the current clinical guidelines.
Main Methods:
- A cohort of 515 RHD patients was assessed using clinical and echocardiographic criteria.
- Stroke aetiology and classification were determined through clinical and neurological assessments.
- Stroke risk was analyzed using Cox models, accounting for competing risks like death.
Main Results:
- The overall incidence of stroke was 1.47 per 100 patient-years, affecting 5.2% of the cohort over a mean follow-up of 3.9 years.
- Predictors of stroke included a history of prior stroke (HR 5.395), increasing age (HR 1.591), and baseline atrial fibrillation (AF) (HR 2.945).
- The predictive value of AF for stroke risk was reduced when death was considered a competing risk (HR 2.287).
Conclusions:
- Stroke affects a notable percentage of RHD patients, with prior stroke, age, and AF being key predictors.
- The influence of atrial fibrillation on stroke risk is moderated by the competing risk of death in RHD patients.
Objective:
Ischaemic stroke is a severe complication of rheumatic heart disease (RHD), which may result in permanent disability and death. This study aimed to assess the incidence and predictors of stroke in patients with RHD in the current era of evidence-based recommendations for prevention.
Methods:
Consecutive patients with RHD diagnosed by clinical and echocardiographic criteria were selected. A structured clinical and neurological assessment was performed to determine the aetiology and classification of stroke at enrolment. The primary endpoint was an ischaemic cerebrovascular event, which included fatal or non-fatal stroke. Risk of stroke was estimated accounting for competing risks.
Results:
A total of 515 patients were enrolled, 438 women (85%), 46±12 years of age. The most frequent valve lesion was mixed mitral (80%). At the time of enrolment, 92 patients (18%) had a prior stroke, with anterior circulation infarction being the most frequent topography (72%). During the mean follow-up of 3.9 years, 27 patients (5.2%) had stroke with the overall incidence of 1.47 strokes per 100 patient-years. Predictors of stroke by the Cox model were prior stroke (adjusted HR 5.395, 95% CI 2.272 to 12.811), age (HR 1.591, 95% CI 1.116 to 2.269) and atrial fibrillation (AF) at baseline (HR 2.945, 95% CI 1.083 to 8.007). By considering death as a competing risk, the effect of AF on stroke risk was attenuated (HR 2.287, 95% CI 0.962 to 5.441).
Conclusions:
In this large cohort of patients with RHD, stroke occurred in 5.2% of the patients, which was predicted by age, AF and prior stroke. The effect of AF on stroke risk estimation was influenced by death as competing risk.
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