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Ischemic stroke risk during post-discharge phases of heart failure: association of left ventricular concentric geometry

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Abstract

Despite a higher risk of ischemic stroke in hospitalized patients with acute heart failure (HF), little is known about the risk of ischemic stroke during the post-discharge phases of HF. Here we investigated (1) the ischemic stroke incidence rate during the post-discharge phases among HF patients receiving standard treatments; (2) the association between ischemic stroke incidence and clinical background, including cardiac structure and function. Among 950 patients who required hospitalization for HF (median duration: 19 days) at our institution, where they received standard treatments, we investigated stroke occurrences during the 2-year period following their discharge and retrospectively evaluated their clinical data. Relative wall thickness (RWT) and left ventricular (LV) mass were determined based on echocardiographic measurements and then used to determine LV geometric patterns. During the follow-up period, ischemic stroke occurred in 25 patients (2.6%) after hospital discharge (1.4 per 100 patient-years). The incidence rate of IS tended to be higher in patients with AF than those without AF (1.8 vs. 1.0 per 100 patient-years, respectively). Notably, multivariate analysis revealed a significant association between RWT and ischemic stroke risk (p < 0.05). RWT was associated with ischemic stroke risk in patients with AF or left atrial enlargement, but not in patients without them. These findings suggest that even with standard HF treatments, the risk of ischemic stroke is high in patients with HF. Moreover, LV concentric geometry is a significant risk factor for ischemic stroke in patients with HF, especially in those with left atrial remodeling and/or AF.

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Acknowledgements

The authors thank all clinical research coordinators and data managers in the National Cerebral and Cardiovascular Center for assistance with data collection and managements in this study.

Funding

This work was partly supported by the Intramural Research Fund of the National Cerebral and Cardiovascular Center of Japan (grants number: 30-1-3 to C.I.).

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, 564-8565, Japan

    Yasuhiro Shintani, Hiroyuki Takahama, Yasuhiro Hamatani, Hideaki Kanzaki, Kengo Kusano, Teruo Noguchi, Satoshi Yasuda & Chisato Izumi

  2. Department of Statics and Data Analysis, National Cerebral and Cardiovascular Center, Suita, Osaka, 564-8565, Japan

    Kunihiro Nishimura

  3. Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, 564-8565, Japan

    Kazunori Toyoda

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  1. Yasuhiro Shintani
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  2. Hiroyuki Takahama
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  3. Yasuhiro Hamatani
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  4. Kunihiro Nishimura
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  5. Hideaki Kanzaki
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  9. Satoshi Yasuda
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  10. Chisato Izumi
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Correspondence to Hiroyuki Takahama.

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Shintani, Y., Takahama, H., Hamatani, Y. et al. Ischemic stroke risk during post-discharge phases of heart failure: association of left ventricular concentric geometry. Heart Vessels 35, 564–575 (2020). https://doi.org/10.1007/s00380-019-01522-x

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