Heart failure in acute ischemic stroke

Ois, Ángel; Gomis, Meritxell; Cuadrado-Godia, Elisa; Jiménez‐Conde, Jordi; Rodríguez-Campello, Ana; Bruguera, Jordi; Molina, Lluís; Comín, Josep; Roquer, Jaume

doi:10.1007/s00415-008-0677-1

Cited by 64 publications

(81 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Clinical factors such as age, stroke severity, atrial fibrillation (AF), female sex, diabetes, and congestive heart failure (CHF) have been associated with poor prognosis after an ischemic stroke (IS) [21,26]. In addition, AF is the main cause of IS in the elderly and is associated with a high mortality and disability rate [12,17].…”

Section: Introductionmentioning

confidence: 99%

CHA2DS2-VASc score and prognosis in ischemic strokes with atrial fibrillation

et al. 2011

View full text Add to dashboard Cite

The CHA(2)DS(2)-VASc score was developed to improve stroke risk stratification in atrial fibrillation (AF) patients. We sought to analyze the distribution and prognostic value of the CHA(2)DS(2)-VASc score in a cohort of ischemic stroke patients with AF. In total, 439 consecutive stroke patients with AF were studied. The CHA(2)DS(2)-VASc score was calculated according to clinical status before stroke onset. Poor outcome was defined as a modified Rankin score of 3 to 6 at 3 months. Association between CHA(2)DS(2)-VASc score and poor outcome was analyzed using logistic regression analysis. In 95.6% of patients, CHA(2)DS(2)-VASc was >1 and only 41.8% of those with previously diagnosed AF were using oral anticoagulation at the time of the stroke. Poor outcome was found in 53.1% of the patients. In univariate analysis age, female sex, current smoking, previous stroke, CHA(2)DS(2)-VASc score, and stroke severity were associated with outcome. In multivariate analysis, CHA(2)DS(2)-VASc score was independently associated with poor outcome [OR 1.36 (95% CI: 1.14-1.62), P = 0.001] as well as NIHSS [OR 1.22 (95% CI: 1.17-1.26), P < 0.001]. After removing stroke severity, therapeutic anticoagulation was also associated with stroke prognosis [OR 0.45 (95% CI: 0.23-0.86), P = 0.016]. Most patients with ischemic stroke and AF have a high CHA(2)DS(2)-VASc score. Independent of stroke severity, CHA(2)DS(2)-VASc score is associated with 3-month outcome. Despite all the available information and guidelines, our AF patients are clearly undertreated.

show abstract

Section: Introductionmentioning

confidence: 99%

CHA2DS2-VASc score and prognosis in ischemic strokes with atrial fibrillation

et al. 2011

View full text Add to dashboard Cite

show abstract

“…In addition, Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events (ACTIVE) trial showed that a risk of embolic event was similar in heart failure with systolic dysfunction (4.4%) and DD (4.3%) [32] . Two studies have shown that heart failure with preserved ejection fraction is prevalent and independently related to poor prognosis after ischemic stroke although they did not directly evaluate diastolic function [3] . In line with previous reports, our data showed that DD is prevalent in stroke patients and is associated with post-stroke outcome.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, DD is related to mortality in patients with myocardial infarct and septic shock [5,6] . With regard to ischemic stroke, only one study showed that DD is associated with moderate to severe functional disability at 3 months after stroke with a relative risk of 2.5 [3] . However, this study was constrained because DD was defined if the patient had heart failure symptoms with normal ejection fraction ( ≥ 50%) [3] .…”

Section: Introductionmentioning

confidence: 99%

“…With regard to ischemic stroke, only one study showed that DD is associated with moderate to severe functional disability at 3 months after stroke with a relative risk of 2.5 [3] . However, this study was constrained because DD was defined if the patient had heart failure symptoms with normal ejection fraction ( ≥ 50%) [3] . In the present study, we investigated whether DD is associated with prognosis after ischemic stroke in terms of functional outcome and mortality using parameters of diastolic function based on tissue Doppler echocardiography.…”

Section: Introductionmentioning

confidence: 99%

“…Patients with reduced ejection fraction had a 2-fold increased risk of in-hospital death compared to those with normal ejection fraction [2] . In addition, systolic heart failure increases the risk of moderate or severe functional disability after stroke [3] .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Diastolic Dysfunction and Outcome in Acute Ischemic Stroke

Ryu

Park²,

Ko³

et al. 2016

Cerebrovasc Dis

View full text Add to dashboard Cite

Background: Left ventricular diastolic dysfunction (DD) is associated with an increased mortality in general population and patients with myocardial infarct. In the present study, we investigated whether DD is associated with outcomes after ischemic stroke. Methods: Five hundred and three acute ischemic stroke patients with normal left ventricular ejection fraction (≥50%) were retrospectively included. Echocardiography and tissue Doppler imaging were used to evaluate and grade diastolic function. Ordinal logistic and Cox regression analyses were used to examine relations between DD and modified Rankin Scale (mRS) score at 3 months and mortality after stroke, respectively. Results: Mean age was 67.2 ± 11.8 years and 63% were men. Among parameters of diastolic function, early mitral inflow velocity/early diastolic mitral annulus velocity (E/e') was independently related with higher mRS score at 3 months and mortality after ischemic stroke. The highest quartile of E/e' (>14) was independently associated with higher mRS score (adjusted OR 3.86, 95% CI 2.27-6.54) as well as with mortality (hazards ratio [HR] 2.87, 95% CI 1.17-7.04) as compared to the lowest quartile of E/e' (<8.8). In addition, moderate-to-severe DD grade was related to higher mRS score (adjusted OR 2.41, 95% CI 1.15-5.06) and mortality (HR 6.63, 95% CI 1.80-24.43) compared to the normal diastolic function. Conclusion: In patients with ischemic stroke, DD is associated with functional outcome at 3 months and mortality. Our data suggest that more attention should be given to DD in patients with ischemic stroke.

show abstract

Ischemic stroke and heart failure: facts and numbers

2015

View full text Add to dashboard Cite

Heart failure (HF) is pandemic in the modern society. Comorbidities of HF come increasingly to the fore in today's patient presentation and demand multidisciplinary treatment concepts. Ischemic stroke is a major comorbidity in HF patients and frequently contributes to the adverse outcome and functional dependency. Patients with HF are two‐fold to three‐fold more likely to suffer an ischemic stroke, have more than two times higher mortality and show worse functional outcome after stroke compared with non‐HF subjects. The risk of recurrent stroke is about two‐fold elevated in patients with HF. The risk of stroke increased with time duration of HF from 18 per 100 cases in the first year of HF to 47 per 1000 patients within the next 4‐5 years. Moreover, so called ‘silent’ strokes (clinically asymptomatic brain lesions) are two to four times more likely in HF patients. In turn, 10–24% of stroke patients have HF. Specific characteristics of the interaction between ischemic stroke and HF have been uncovered in recent years. However, gaps in present knowledge need to be addressed in future studies. What are the detailed pathophysiologic links beyond atrial fibrillation, stroke patterns, and time courses in the interaction? What implication has HF with preserved versus reduced ejection fraction? Does treatment of HF prevents ischemic stroke or reduces stroke‐related sequelae? This editorial provides a condensed overview on current insights and presents facts and numbers on the interaction between heart failure and ischemic stroke.

show abstract

Heart failure in acute ischemic stroke

Abstract: Both forms of HF (with or without decreased systolic function) are associated with poor outcome in AIS.

Cited by 64 publications

References 29 publications

CHA2DS2-VASc score and prognosis in ischemic strokes with atrial fibrillation

CHA2DS2-VASc score and prognosis in ischemic strokes with atrial fibrillation

Diastolic Dysfunction and Outcome in Acute Ischemic Stroke

Ischemic stroke and heart failure: facts and numbers

Contact Info

Product

Resources

About