TY - JOUR
T1 - Incidence and predictors of stroke in patients with rheumatic heart disease
AU - Vasconcelos, Marcelle
AU - Vasconcelos, Luiz
AU - Ribeiro, Victor
AU - Campos, Carolina
AU - Di-Flora, Francisco
AU - Abreu, Lara
AU - Silva, Lucas
AU - Diamantino, Tatiana
AU - Padilha Da Silva, Jose Luiz
AU - Esteves, William Antonio M.
AU - Teixeira, Antonio Lucio
AU - Nunes, Maria Carmo Pereira
N1 - Publisher Copyright:
© Author(s) 2021 (or their employer(s)). No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2021/5/1
Y1 - 2021/5/1
N2 - Objective Ischaemic stroke is a severe complication of rheumatic heart disease (RHD), which may result in permanent disability and death. This study aimed to assess the incidence and predictorsof stroke in patients with RHD in the current era of evidence-based recommendations for prevention.Methods Consecutive patients with RHD diagnosed by clinical and echocardiographic criteria were selected. A structured clinical and neurological assessment was performed to determine the aetiology and classification of stroke at enrolment. The primary endpoint was an ischaemic cerebrovascular event, which included fatal or non-fatal stroke. Risk of stroke was estimated accounting for competingrisks. Results A total of 515 patients were enrolled, 438 women (85%), 46±12 years of age. The most frequent valve lesion was mixed mitral (80%). At the time of enrolment, 92 patients (18%) had a prior stroke, with anterior circulation infarction being the most frequent topography (72%). During the mean follow-up of 3.9 years, 27 patients (5.2%) had stroke with the overall incidence of 1.47 strokes per 100 patient-years. Predictors of stroke by the Cox model were prior stroke (adjusted HR 5.395, 95% CI 2.272 to 12.811), age (HR 1.591, 95% CI 1.116 to 2.269) and atrial fibrillation(AF) at baseline (HR 2.945, 95% CI 1.083 to 8.007). By considering death as a competing risk, the effect of AF on stroke risk was attenuated (HR 2.287, 95% CI 0.962 to 5.441). Conclusions In this large cohort of patients with RHD, stroke occurred in 5.2% of the patients, which was predicted by age, AF and prior stroke. The effect of AF on stroke risk estimation was influenced by death as competing risk.
AB - Objective Ischaemic stroke is a severe complication of rheumatic heart disease (RHD), which may result in permanent disability and death. This study aimed to assess the incidence and predictorsof stroke in patients with RHD in the current era of evidence-based recommendations for prevention.Methods Consecutive patients with RHD diagnosed by clinical and echocardiographic criteria were selected. A structured clinical and neurological assessment was performed to determine the aetiology and classification of stroke at enrolment. The primary endpoint was an ischaemic cerebrovascular event, which included fatal or non-fatal stroke. Risk of stroke was estimated accounting for competingrisks. Results A total of 515 patients were enrolled, 438 women (85%), 46±12 years of age. The most frequent valve lesion was mixed mitral (80%). At the time of enrolment, 92 patients (18%) had a prior stroke, with anterior circulation infarction being the most frequent topography (72%). During the mean follow-up of 3.9 years, 27 patients (5.2%) had stroke with the overall incidence of 1.47 strokes per 100 patient-years. Predictors of stroke by the Cox model were prior stroke (adjusted HR 5.395, 95% CI 2.272 to 12.811), age (HR 1.591, 95% CI 1.116 to 2.269) and atrial fibrillation(AF) at baseline (HR 2.945, 95% CI 1.083 to 8.007). By considering death as a competing risk, the effect of AF on stroke risk was attenuated (HR 2.287, 95% CI 0.962 to 5.441). Conclusions In this large cohort of patients with RHD, stroke occurred in 5.2% of the patients, which was predicted by age, AF and prior stroke. The effect of AF on stroke risk estimation was influenced by death as competing risk.
KW - atrial fibrillation
KW - stroke
KW - valvular heart disease
UR - http://www.scopus.com/inward/record.url?scp=85099089840&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85099089840&partnerID=8YFLogxK
U2 - 10.1136/heartjnl-2020-318054
DO - 10.1136/heartjnl-2020-318054
M3 - Article
C2 - 33414162
AN - SCOPUS:85099089840
SN - 1355-6037
VL - 107
SP - 748
EP - 754
JO - Heart
JF - Heart
IS - 9
ER -