From Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (A.H.A.-R., A.-C.P., R.L.F., P.S.J., K.R.L., J.J.V.M.); IRCCS-RL: Istituto Mario Negri, Milan, Italy (R.L.); Consorzio Mario Negri Sud, S Maria Imbaro, Italy (G.T.); Sahlgrenska Academy, Gothenburg University, Sweden (J.W.); Rikshospitalet University Hospital, Oslo, Norway (J.K.); University of Birmingham, Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom (G.Y.H.L.); Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.); ANMCO Research Center, Florence, Italy (A.P.M.); and Maria Cecilia Hospital, GVM Care&Research - E.S. Health Science Foundation, Cotignola, Italy (L.T.).
Circulation. 2015 Apr 28;131(17):1486-94; discussion 1494. doi: 10.1161/CIRCULATIONAHA.114.013760. Epub 2015 Mar 25.
Our aim was to describe the incidence and predictors of stroke in patients who have heart failure without atrial fibrillation (AF).
We pooled 2 contemporary heart failure trials, the Controlled Rosuvastatin in Multinational Trial Heart Failure (CORONA) and the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza cardiaca-Heart Failure trial (GISSI-HF). Of the 9585 total patients, 6054 did not have AF. Stroke occurred in 165 patients (4.7%) with AF and in 206 patients (3.4%) without AF (rates 16.8/1000 patient-years and 11.1/1000 patient-years, respectively). Using Cox proportional-hazards models, we identified the following independent predictors of stroke in patients without AF (ranked by χ(2) value): age (hazard ratio, 1.34; 95% confidence interval, 1.18-1.63 per 10 years), New York Heart Association class (1.60, 1.21-2.12 class III/IV versus II), diabetes mellitus treated with insulin (1.87, 1.22-2.88), body mass index (0.74, 0.60-0.91 per 5 kg/m(2) up to 30), and previous stroke (1.81, 1.19-2.74). N-terminal pro B-type natriuretic peptide (available in 2632 patients) was also an independent predictor of stroke (hazard ratio, 1.31; 1.11-1.57 per log unit) when added to this model. With the use of a risk score formulated from these predictors, we found that patients in the upper third of risk had a rate of stroke that approximated the risk in patients with AF.
A small number of demographic and clinical variables identified a subset of patients who have heart failure without AF at a high risk of stroke.
本研究旨在描述患有心力衰竭且无心房颤动（AF）患者的卒中发生率及预测因素。
我们汇总了 2 项当代心力衰竭试验，即控制瑞舒伐他汀多国心力衰竭试验（CORONA）和意大利心力衰竭生存研究（GISSI-HF）。在总计 9585 例患者中，有 6054 例患者无 AF。AF 患者中有 165 例（4.7%）和无 AF 患者中有 206 例（3.4%）发生卒中（发生率分别为 16.8/1000 患者年和 11.1/1000 患者年）。使用 Cox 比例风险模型，我们鉴定出无 AF 患者卒中的独立预测因素（按 χ(2) 值排序）：年龄（风险比，1.34；95%置信区间，每增加 10 岁增加 1.18-1.63）、纽约心脏病协会心功能分级（1.60，III/IV 级比 II 级）、胰岛素治疗的糖尿病（1.87，1.22-2.88）、体质指数（每增加 5kg/m(2)降低 0.74，0.60-0.91 至 30）和既往卒中（1.81，1.19-2.74）。当将 N 末端脑钠肽前体（pro B-type natriuretic peptide，NT-proBNP，在 2632 例患者中可检测）加入到该模型中时，其也是卒中的独立预测因素（风险比，1.31；1.11-1.57，每增加 1 个对数单位）。应用该预测因素制定风险评分后，我们发现风险评分较高的患者中卒中发生率接近有 AF 的患者。
少数人口统计学和临床变量确定了具有心力衰竭且无 AF 的患者亚组，该亚组具有较高的卒中风险。
