British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (T.K., P.S.J., M.C.P., J.J.V.M.).
Department of Cardiology, Nagoya University Graduate School of Medicine, Japan (T.K.).
Circ Heart Fail. 2023 Jul;16(7):e010377. doi: 10.1161/CIRCHEARTFAILURE.122.010377. Epub 2023 Jun 23.
The rate of stroke in patients with heart failure (HF) and preserved ejection fraction but without atrial fibrillation (AF), is uncertain as is whether it is possible to reliably predict the risk of stroke in these patients.
We validated a previously developed simple risk model for stroke among patients enrolled in the I-Preserve trial (Irbesartan in Heart Failure With Preserved Systolic Function) and PARAGON-HF trial (Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction). The risk model consisted of 3 variables: history of previous stroke, insulin-treated diabetes, and plasma N-terminal pro-B-type natriuretic peptide level.
Of the 8924 patients included in the pooled trial dataset, 5126 patients did not have AF at baseline. Among patients without AF, 190 (3.7%) experienced a stroke over a median follow-up of 3.6 years (rate 10.5 per 1000 patient-years). The risk for stroke increased with increasing risk score: second tertile hazard ratio, 1.78 (95% CI, 1.17-2.71); third tertile hazard ratio, 3.03 (95% CI, 2.06-4.47), with the first tertile as reference. For patients in the third tertile, the occurrence rate of stroke was 17.7 per 1000 patient-years, similar to that in patients with AF not receiving anticoagulation (20.7 per 1000 patient-years), and those with AF who were receiving anticoagulation (14.5 per 1000 patient-years). Model discrimination was good with a C index of 0.81 (0.68-0.91) and a simple score could be created from the model.
A simple risk model can detect a subset of HF and preserved ejection fraction patients without AF who have a higher risk for stroke. The balance of risk-to-benefit in these individuals may justify the use of prophylactic anticoagulation, but this hypothesis needs to be prospectively evaluated.
URL: https://www.
gov; Unique identifiers: NCT00095238 and NCT01920711.
心力衰竭（HF）伴射血分数保留但无房颤（AF）患者的中风发生率尚不确定，能否可靠预测这些患者的中风风险也不确定。
我们验证了先前开发的一种简单的中风风险模型，该模型适用于 I-Preserve 试验（HF 伴射血分数保留的伊贝沙坦）和 PARAGON-HF 试验（LCZ696 与缬沙坦在 HF 伴射血分数保留患者中的疗效和安全性比较）中纳入的患者。该风险模型由 3 个变量组成：既往中风史、胰岛素治疗的糖尿病和血浆 N 末端 pro-B 型利钠肽水平。
在汇总试验数据集的 8924 例患者中，5126 例患者基线时无 AF。在无 AF 的患者中，190 例（3.7%）在中位随访 3.6 年后发生中风（发生率为 10.5/1000 患者年）。随着风险评分的增加，中风风险增加：第二 tert 危险比为 1.78（95%CI，1.17-2.71）；第三 tert 危险比为 3.03（95%CI，2.06-4.47），以第一 tert 为参考。对于处于第三 tert 的患者，中风发生率为 17.7/1000 患者年，与未接受抗凝治疗的 AF 患者相似（20.7/1000 患者年），与接受抗凝治疗的 AF 患者相似（14.5/1000 患者年）。该模型具有良好的判别能力，C 指数为 0.81（0.68-0.91），可以从模型中创建一个简单的评分。
一种简单的风险模型可以检测出 HF 和射血分数保留的无 AF 患者亚组，这些患者中风风险较高。这些个体的风险-获益平衡可能证明预防性抗凝是合理的，但这一假设需要前瞻性评估。
网址：https://www.clinicaltrials.gov；唯一标识符：NCT00095238 和 NCT01920711。
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