Incidence and predictors of stroke in patients with rheumatic heart disease

Marcelle Vasconcelos, Luiz Vasconcelos, Victor Ribeiro, Carolina Campos, Francisco Di-Flora, Lara Abreu, Lucas Silva, Tatiana Diamantino, Jose Luiz Padilha Da Silva, William Antonio M. Esteves, Antonio Lucio Teixeira, Maria Carmo Pereira Nunes

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)748-754
Number of pages7
Issue number9
StatePublished - May 1 2021
Externally publishedYes


  • atrial fibrillation
  • stroke
  • valvular heart disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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