Risk of stroke in chronic heart failure patients with preserved ejection fraction, but without atrial fibrillation: analysis of the CHARM-Preserved and I-Preserve trials

Abstract

AimsThe incidence and predictors of stroke in patients with heart failure and preserved ejection fraction (HF-PEF), but without atrial fibrillation (AF), are unknown. We described the incidence of stroke in HF-PEF patients with and without AF and predictors of stroke in those without AF.Methods and resultsWe pooled data from the CHARM-Preserved and I-Preserve trials. Using Cox regression, we derived a model for stroke in patients without AF in this cohort and compared its performance with a published model in heart failure patients with reduced ejection fraction (HF-REF)—predictive variables: age, body mass index, New York Heart Association class, history of stroke, and insulin-treated diabetes. The two stroke models were compared and Kaplan–Meier curves for stroke estimated. The risk model was validated in a third HF-PEF trial. Of the 6701 patients, 4676 did not have AF. Stroke occurred in 124 (6.1%) with AF and in 171 (3.7%) without AF (rates 1.80 and 1.00 per 100 patient-years, respectively). There was no difference in performance of the stroke model derived in the HF-PEF cohort and the published HF-REF model (c-index 0.71, 95% confidence interval 0.57–0.84 vs. 0.73, 0.59–0.85, respectively) as the predictive variables overlapped. The model performed well in the validation cohort (0.86, 0.62–0.99). The rate of stroke in patients in the upper third of risk approximated to that in patients with AF (1.60 and 1.80 per 100 patient-years, respectively).ConclusionsA small number of clinical variables identify a subset of patients with HF-PEF, but without AF, at elevated risk of stroke.

Prediction of Thromboembolic Events in Heart Failure Patients in Sinus Rhythm: The Hong Kong Heart Failure Registry

“…[32] They have found that patients with HFREF and HFPEF share similar risk factors for stroke. [32] In addition, they have shown that the risk model derived from the HFREF cohort predicts stroke in patients with HFPEF with comparable c -index.…”

“…[32] They have found that patients with HFREF and HFPEF share similar risk factors for stroke. [32] In addition, they have shown that the risk model derived from the HFREF cohort predicts stroke in patients with HFPEF with comparable c -index. [5, 32] Similarly, our study did not find any significant differences in the ability of the CHA 2 DS 2 -VASc-HK 2 score in predicting TE among patients with HFREF and HFPEF.…”

“…[32] In addition, they have shown that the risk model derived from the HFREF cohort predicts stroke in patients with HFPEF with comparable c -index. [5, 32] Similarly, our study did not find any significant differences in the ability of the CHA 2 DS 2 -VASc-HK 2 score in predicting TE among patients with HFREF and HFPEF. These findings suggest that although the risk factors for HFREF and HFPEF are different, the risk factors for TE in HF remain similar.…”

Protective mechanism of SIRT1 on Hcy‐induced atrial fibrosis mediated by TRPC3

“…(HF) due to the accumulation of collagen fibres, such that patients with AF have HF with a preserved ejection fraction (HFpEF) rather than HF with reduced ejection fraction (HFrEF), accounting for 30% of cases. [5][6][7] These findings suggest that the atrial fibrosis is associated with collagen metabolism and is involved in the mechanism of AF. Furthermore, hyperhomocysteinemia is a pathological feature in the aetiology of atrial fibrosis, although the underlying mechanisms remain unclear.…”

Arrhythmias in patients with chronic heart failure and preserved ejection fraction

“…Среди причин смерти пациентов с ХСН-СФВ большую долю занимают жизнеугрожающие нарушения ритма -до 18 % летальных исходов имеют аритмический генез [6]. В исследовании I-Preserve у 6,1 % больных был диагности-рован мозговой инсульт тромбоэмболического проис-хождения на фоне фибрилляции предсердий (ФП), в 26 % случаев наблюдалась внезапная сердечная смерть (ВСС) [7,8]. Следует отметить, что, по данным многочисленных эпидемиологических исследований, основными причина-ми ВСС являются желудочковые нарушения ритма серд-ца (ЖНРС) -желудочковая тахикардия (ЖТ) и фибрил-ляция желудочков [9].…”