Frontera Jennifer A, Starling Randall, Cho Sung-Min, Nowacki Amy S, Uchino Ken, Hussain M Shazam, Mountis Maria, Moazami Nader
Department of Neurology, New York University, New York, New York.
Kaufman Center for Heart Failure and Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
J Heart Lung Transplant. 2017 Jun;36(6):673-683. doi: 10.1016/j.healun.2016.12.010. Epub 2016 Dec 23.
Stroke is a major cause of mortality after left ventricular assist device (LVAD) placement.
Prospectively collected data of patients with HeartMate II (n = 332) and HeartWare (n = 70) LVADs from October 21, 2004, to May 19, 2015, were reviewed. Predictors of early (during index hospitalization) and late (post-discharge) ischemic and hemorrhagic stroke and association of stroke subtypes with mortality were assessed.
Of 402 patients, 83 strokes occurred in 69 patients (17%; 0.14 events per patient-year [EPPY]): early ischemic stroke in 18/402 (4%; 0.03 EPPY), early hemorrhagic stroke in 11/402 (3%; 0.02 EPPY), late ischemic stroke in 25/402 (6%; 0.04 EPPY) and late hemorrhagic stroke in 29/402 (7%; 0.05 EPPY). Risk of stroke and death among patients with stroke was bimodal with highest risks immediately post-implant and increasing again 9-12 months later. Risk of death declined over time in patients without stroke. Modifiable stroke risk factors varied according to timing and stroke type, including tobacco use, bacteremia, pump thrombosis, pump infection, and hypertension (all p < 0.05). In multivariable analysis, early hemorrhagic stroke (adjusted odds ratio [aOR] 4.3, 95% confidence interval [CI] 1.0-17.8, p = 0.04), late ischemic stroke (aOR 3.2, 95% CI 1.1-9.0, p = 0.03), and late hemorrhagic stroke (aOR 3.7, 95% CI 1.5-9.2, p = 0.005) predicted death, whereas early ischemic stroke did not.
Stroke is a leading cause and predictor of death in patients with LVADs. Risk of stroke and death among patients with stroke is bimodal, with highest risk at time of implant and increasing risk again after 9-12 months. Management of modifiable risk factors may reduce stroke and mortality rates.
中风是左心室辅助装置（LVAD）植入术后死亡的主要原因。
回顾性分析2004年10月21日至2015年5月19日期间前瞻性收集的使用HeartMate II（n = 332）和HeartWare（n = 70）LVAD患者的数据。评估早期（指数住院期间）和晚期（出院后）缺血性和出血性中风的预测因素以及中风亚型与死亡率的关联。
402例患者中，69例患者发生了83次中风（17%；每位患者每年0.14次事件[EPPY]）：18/402例（4%；0.03 EPPY）为早期缺血性中风，11/402例（3%；0.02 EPPY）为早期出血性中风，25/402例（6%；0.04 EPPY）为晚期缺血性中风，29/402例（7%；0.05 EPPY）为晚期出血性中风。中风患者的中风和死亡风险呈双峰模式，植入后即刻风险最高，9 - 12个月后再次增加。无中风患者的死亡风险随时间下降。可改变的中风风险因素根据时间和中风类型而异，包括吸烟、菌血症、泵血栓形成、泵感染和高血压（均p < 0.05）。在多变量分析中，早期出血性中风（调整后的优势比[aOR] 4.3，95%置信区间[CI] 1.0 - 17.8，p = 0.04）、晚期缺血性中风（aOR 3.2，95% CI 1.1 - 9.0，p = 0.03）和晚期出血性中风（aOR 3.7，95% CI 1.5 - 9.2，p = 0.005）可预测死亡，而早期缺血性中风则不能。
中风是LVAD患者死亡的主要原因和预测因素。中风患者的中风和死亡风险呈双峰模式，植入时风险最高，9 - 12个月后风险再次增加。管理可改变的风险因素可能降低中风和死亡率。
