Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Nov 2021)

Ischemic Stroke in Acute Decompensated Heart Failure: From the KCHF Registry

  • Moritake Iguchi,
  • Takao Kato,
  • Hidenori Yaku,
  • Takeshi Morimoto,
  • Yasutaka Inuzuka,
  • Yodo Tamaki,
  • Neiko Ozasa,
  • Erika Yamamoto,
  • Yusuke Yoshikawa,
  • Takeshi Kitai,
  • Yasuhiro Hamatani,
  • Yugo Yamashita,
  • Nobutoyo Masunaga,
  • Hisashi Ogawa,
  • Mitsuru Ishii,
  • Yoshimori An,
  • Ryoji Taniguchi,
  • Masashi Kato,
  • Mamoru Takahashi,
  • Toshikazu Jinnai,
  • Tomoyuki Ikeda,
  • Kazuya Nagao,
  • Takafumi Kawai,
  • Akihiro Komasa,
  • Ryusuke Nishikawa,
  • Yuichi Kawase,
  • Takashi Morinaga,
  • Mitsunori Kawato,
  • Yuta Seko,
  • Mamoru Toyofuku,
  • Yutaka Furukawa,
  • Kenji Ando,
  • Kazushige Kadota,
  • Mitsuru Abe,
  • Masaharu Akao,
  • Yukihito Sato,
  • Koichiro Kuwahara,
  • Takeshi Kimura

DOI
https://doi.org/10.1161/JAHA.121.022525
Journal volume & issue
Vol. 10, no. 21

Abstract

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Background Heart failure (HF) is a known risk factor for ischemic stroke, but data regarding ischemic stroke during hospitalization for acute decompensated HF (ADHF) are limited. Methods and Results We analyzed the data from a multicenter registry (Kyoto Congestive Heart Failure [KCHF] Registry) that enrolled 4056 consecutive patients with ADHF in Japan (mean age, 78 years; men, 2238 patients [55%]; acute coronary syndrome [ACS], 239 patients [5.9%]). We investigated the incidence and predictors of ischemic stroke during hospitalization for ADHF. During the hospitalization, 63 patients (1.6%) developed ischemic stroke. The median interval from admission to the onset of ischemic stroke was 7 [interquartile range: 2–14] days, and the most common underlying cause was cardioembolism (64%). Men (OR, 1.87; 95%CI, 1.11–3.24), ACS (OR, 2.31; 95%CI, 1.01–4.93), absence of prior HF hospitalization (OR, 2.21; 95%CI, 1.24–4.21), and high B‐type natriuretic peptide (BNP)/N‐terminal proBNP (NT‐proBNP) levels (above the median) at admission (OR, 3.15; 95%CI, 1.84–5.60) were independently associated with ischemic stroke. In patients without ACS, the independent risk factors for ischemic stroke were fully consistent with those in the main analysis. Higher quartiles of BNP/NT‐proBNP levels were significantly associated with higher incidence of ischemic stroke (P for trend, <0.001). Patients with ischemic stroke showed higher in‐hospital mortality, longer length of hospital stay, and poorer functional status at discharge. Conclusions During hospitalization for ADHF, 1.6% of the patients developed ischemic stroke. Men, ACS, absence of prior HF hospitalization, and high BNP/NT‐proBNP levels at admission were independently associated with ischemic stroke.

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