Procoagulant State in Heart Failure With Preserved Left Ventricular Ejection Fraction

Jug, Borut; Vene, Nina; Salobir, Barbara; Šebeštjen, Miran; Šabovič, Mišo; Keber, Irena

doi:10.1536/ihj.50.591

Cited by 54 publications

(41 citation statements)

References 34 publications

(31 reference statements)

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“…2,3 First, patients with HF may have stasis of blood flow (blood flow abnormalities) related to left ventricular systolic dysfunction and dyskinesis. 4,5 Second, patients with HF also have endocardial and endothelial dysfunction (vessel wall abnormalities). 4,5 Both of these problems may also lead to cerebral hypoperfusion and cerebral blood flow dysregulation, further increasing the risk of stroke.…”

Section: Hf Particularly Hf With Reduced Ejection Fraction (Hf-ref)mentioning

confidence: 99%

“…4,5 Second, patients with HF also have endocardial and endothelial dysfunction (vessel wall abnormalities). 4,5 Both of these problems may also lead to cerebral hypoperfusion and cerebral blood flow dysregulation, further increasing the risk of stroke. Third, patients with HF have a hypercoagulable state (abnormal blood constituents).…”

Section: Hf Particularly Hf With Reduced Ejection Fraction (Hf-ref)mentioning

confidence: 99%

“…Third, patients with HF have a hypercoagulable state (abnormal blood constituents). 4,5 Importantly, with the availability of highly effective oral anticoagulant treatment, strokes potentially related to these factors may be preventable. In the Warfarin/ Aspirin Study in Heart Failure (WASH), there was no significant difference among the groups of patients receiving warfarin, aspirin, and placebo, in the composite end point of death, stroke, or myocardial infarction, although this was a small trial.…”

Section: Hf Particularly Hf With Reduced Ejection Fraction (Hf-ref)mentioning

confidence: 99%

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Risk of Stroke in Chronic Heart Failure Patients Without Atrial Fibrillation

Abdul-Rahim¹,

Perez²,

Fulton³

et al. 2015

Circulation

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Background— Our aim was to describe the incidence and predictors of stroke in patients who have heart failure without atrial fibrillation (AF). Methods and Results— We pooled 2 contemporary heart failure trials, the Controlled Rosuvastatin in Multinational Trial Heart Failure (CORONA) and the Gruppo Italiano per lo Studio della Sopravvivenza nell’Insufficienza cardiaca-Heart Failure trial (GISSI-HF). Of the 9585 total patients, 6054 did not have AF. Stroke occurred in 165 patients (4.7%) with AF and in 206 patients (3.4%) without AF (rates 16.8/1000 patient-years and 11.1/1000 patient-years, respectively). Using Cox proportional-hazards models, we identified the following independent predictors of stroke in patients without AF (ranked by χ 2 value): age (hazard ratio, 1.34; 95% confidence interval, 1.18–1.63 per 10 years), New York Heart Association class (1.60, 1.21–2.12 class III/IV versus II), diabetes mellitus treated with insulin (1.87, 1.22–2.88), body mass index (0.74, 0.60–0.91 per 5 kg/m 2 up to 30), and previous stroke (1.81, 1.19–2.74). N-terminal pro B-type natriuretic peptide (available in 2632 patients) was also an independent predictor of stroke (hazard ratio, 1.31; 1.11–1.57 per log unit) when added to this model. With the use of a risk score formulated from these predictors, we found that patients in the upper third of risk had a rate of stroke that approximated the risk in patients with AF. Conclusions— A small number of demographic and clinical variables identified a subset of patients who have heart failure without AF at a high risk of stroke.

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Section: Hf Particularly Hf With Reduced Ejection Fraction (Hf-ref)mentioning

confidence: 99%

Section: Hf Particularly Hf With Reduced Ejection Fraction (Hf-ref)mentioning

confidence: 99%

Section: Hf Particularly Hf With Reduced Ejection Fraction (Hf-ref)mentioning

confidence: 99%

See 1 more Smart Citation

Risk of Stroke in Chronic Heart Failure Patients Without Atrial Fibrillation

Abdul-Rahim¹,

Perez²,

Fulton³

et al. 2015

Circulation

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“…[3,8] HF has been shown to be an independent risk factor for stroke in AF and the presence of both conditions together leads to an increase in stroke severity and all-cause mortality [5,7,32,33]. Stroke in HF is most commonly associated with AF, however there is evidence that HF 'per se' even in the absence of AF also confers a hypercoagulable state [34,35]. Data from a recent meta-analysis comparing outcomes of patients with atrial fibrillation and HFrEF versus HFpEF have demonstrated that there were no significant differences in the risk of stroke between the two (RR 0.85, 95% CI 0.70-1.03, p=0.094) [26].…”

Section: Stroke Risk In Atrial Fibrillation and Heart Failurementioning

confidence: 99%

Atrial fibrillation and heart failure: Factors influencing the choice of oral anticoagulant

Brown

Boos

2017

International Journal of Cardiology

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Atrial fibrillation (AF) and heart failure (HF) frequently coexist. AF is identified in approximately one third of patients with HF and is linked to increased morbidity and mortality than from either condition alone. AF is relatively more common in HF with preserved ejection fraction (HFpEF) than with reduced ejection fraction (HFrEF).Nevertheless, the risk of stroke and systemic embolism (SSE) is significantly increased with both HF types and the absolute risk is heavily influenced by the presence and severity of associated additional stroke risk factors. The European Society of Cardiology has very recently introduced a third HF subtype entitled HF with mid-range ejection fraction (HFmrEF). At present oral anticoagulation is recommended for all patients with AF and HF, independent of HF type. In addition to warfarin there are currently four non-vitamin K oral anticoagulants (NOACs, previously called novel oral anticoagulants) that have been approved for the prevention of SSE. They consist of one direct thrombin inhibitor, dabigatran and three factor Xa inhibitors: rivaroxaban, apixaban and, most recently, edoxaban. In this review article we present an overview of the evidence to support the use of NOACs for the prevention of SSE in patients with AF and HF and review the influence of HF subtype and co-morbidities on the potential choice of oral anticoagulant.

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“…In patients with chronic heart failure (CHF), the activation of the sympathetic nervous system and the reninangiotensin-aldosterone system induces a hypercoagulable state, increased aggregation of thrombocytes, and reduced fibrinolysis [1,2]. Moreover, CHF patients have endothelial dysfunction, malfunction of cerebral autoregulation and rheological alterations consistent with flow abnormality via low cardiac output and aberrant flow through dilated cardiac chambers [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

The CHADS2 score predicts ischemic stroke in chronic heart failure patients without atrial fibrillation: comparison to other stroke risk scores

et al. 2016

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The CHADS score is useful in stratifying the risk of ischemic stroke or transient ischemic attack (TIA) in patients with non-valvular atrial fibrillation (AF). However, it remains unclear whether the CHADS score could predict stroke or TIA in chronic heart failure (CHF) patients without AF. Recently, the new stroke risk score was proposed from 2 contemporary heart failure trials. We evaluated the prognostic power of the CHADS score for stroke or TIA in CHF patients without AF in comparison to the "stroke risk score". We retrospectively studied 127 CHF patients [left ventricular ejection fraction (LVEF) <40 %] without AF, who had been enrolled in our previous prospective cohort study. The primary endpoint was the incidence of stroke or TIA. The mean baseline CHADS score was 2.1 ± 1.0. During the follow-up period of 8.4 ± 5.1 years, stroke or TIA occurred in 21 of 127 patients. At multivariate Cox analysis, CHADS score (C-index 0.794), but not "stroke risk score" (C-index 0.625), was significantly and independently associated with stroke or TIA. The incidence of stroke or TIA appeared to increase in relation to the CHADS score [low (=1), 0 per 100 person-years; intermediate (=2), 1.6 per 100 person-years; high (≥3), 4.7 per 100 person-years; p = 0.04]. CHADS score could stratify the risk of ischemic stroke in CHF patients with the absence of AF, with greater prognostic power than the "stroke risk score".

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Procoagulant State in Heart Failure With Preserved Left Ventricular Ejection Fraction

Cited by 54 publications

References 34 publications

Risk of Stroke in Chronic Heart Failure Patients Without Atrial Fibrillation

Risk of Stroke in Chronic Heart Failure Patients Without Atrial Fibrillation

Atrial fibrillation and heart failure: Factors influencing the choice of oral anticoagulant

The CHADS2 score predicts ischemic stroke in chronic heart failure patients without atrial fibrillation: comparison to other stroke risk scores

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