Department of Cardiology, The Key Laboratory of Cardiovascular Disease of Wenzhou, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, P.R. China.
Department of Nephrology, Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, P.R. China.
Aging (Albany NY). 2021 Feb 1;13(4):5332-5341. doi: 10.18632/aging.202458.
Patients with heart failure are at increased risk for ischemic stroke. We aim to develop a more accurate stroke risk prediction tools identify high-risk patients with heart failure with reduced ejection fraction (HFrEF). Patient data were extracted retrospectively from the electronic medical database between January 2009 and February 2019. Univariate and multivariate Cox regression analysis were performed to identify independent predictors, which were utilized to construct a nomogram for predicting ischemic stroke. AUROC analysis was used to compare the prognostic value between the new risk score and CHADS/CHADS-VASc scores. In 6087 patients with HFrEF, the risk of first-ever ischemic stroke was 5.8% events/pts-years (n=468) during 8007.2 person-years follow-up. A nomogram constructed by integrating 6 variables, including age, atrial fibrillation (AF), deep vein thrombosis (DVT), d-dimer, anticoagulant use and spontaneous echocardiographic contrast (SEC)/left ventricular thrombus (LVT), exhibited a greater area under the curve of 0.727, 0.728 and 0.714 than that by CHADS score (0.515, 0.522 and 0.540), and by CHADS-VASc score (0.547, 0.553 and 0.562) for predicting first-ever ischemic stroke at hospitalization, 30-day and 6-month follow-up (all p<0.001). This novel stroke risk score performed better than existing CHADS/ CHADS-VASc scores and showed improvement in predicting first-ever ischemic stroke in HFrEF patients.
心力衰竭患者发生缺血性卒中的风险增加。我们旨在开发一种更准确的卒中风险预测工具，以识别射血分数降低的心力衰竭（HFrEF）高危患者。患者数据从 2009 年 1 月至 2019 年 2 月的电子病历数据库中回顾性提取。进行单变量和多变量 Cox 回归分析以确定独立预测因子，并用这些因子构建预测缺血性卒中的列线图。AUROC 分析用于比较新风险评分与 CHADS/CHADS-VASc 评分之间的预后价值。在 6087 例 HFrEF 患者中，8007.2 人年随访期间首次发生缺血性卒中的风险为 5.8%（n=468）。由 6 个变量（包括年龄、心房颤动（AF）、深静脉血栓形成（DVT）、D-二聚体、抗凝治疗和自发性超声心动图对比（SEC）/左心室血栓（LVT））构建的列线图，其预测住院、30 天和 6 个月随访时首次发生缺血性卒中的曲线下面积分别为 0.727、0.728 和 0.714，均大于 CHADS 评分（0.515、0.522 和 0.540）和 CHADS-VASc 评分（0.547、0.553 和 0.562）（均 P<0.001）。该新型卒中风险评分优于现有 CHADS/CHADS-VASc 评分，可改善对 HFrEF 患者首次缺血性卒中的预测。
