Stroke Risk Following Infection in Patients with Continuous-Flow Left Ventricular Assist Device
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Infection has been associated with stroke in patients with left ventricular assist devices (LVAD); however, little data exist on the timing, type and mortality impact of infection-related stroke.
Prospectively collected data of HeartMate II (N = 332) and HeartWare (N = 70) LVAD patients from a single center were reviewed. Only strokes (ischemic or hemorrhagic) that occurred within 6 weeks following a LVAD infection were considered in analyses. The association between LVAD infections (wound, pump pocket, driveline and/or bloodstream infection [BSI]), specific pathogens and ischemic and hemorrhagic strokes was evaluated using multivariable logistic regression analysis. The impact of infection-related stroke on cumulative survival was assessed using Kaplan–Meier analysis.
Of 402 patients, LVAD infection occurred in 158 (39%) including BSI in 107 (27%), driveline infection in 67 (17%), wound infection in 31 (8%) and pump pocket infection in 24 (6%). LVAD infection-related stroke occurred in 20/158 (13%) patients in a median of 4 days (0–36 days) from documented infection. In multivariable analysis, ischemic stroke was associated with wound infection (aOR 9.0, 95% CI 2.4–34.0, P = 0.001) and BSI (aOR 7.7, 95% CI 0.9–66.0, P = 0.064), and hemorrhagic stroke was associated with BSI in 100% of cases (P = 0.01). There was no association with driveline or pump pocket infection. The cumulative survival rate among patients with infection-related stroke was significantly lower compared to those with LVAD infection but no stroke (log-rank P < 0.001). There was a trend toward shorter stroke-free survival among patients with LVAD infection.
LVAD infections, particularly BSI, are significantly associated with stroke, and infection-related stroke conferred significantly lower cumulative survival.
KeywordsLeft ventricular assist device (LVAD) HeartWare (HVAD) HeartMate II (HM II) Stroke Ischemic stroke Hemorrhagic stroke Infection
SMC and JAF contributed to study concept and design. SMC and JAF contributed to data acquisition and analysis. JAF reviewed and finalized the statistical analysis. SMC prepared the first draft of the manuscript. SK, AB, NM and NKS contributed to drafting the manuscript. SMC and JAF finalized the manuscript.
Source of Support
No targeted funding reported.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no competing interests.
This study was approved by the Cleveland Clinic IRB, and all patients or their surrogates consented to participation.
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