Incidence and Outcomes of Patients With Early Cardiac Complications After Intracerebral Hemorrhage: A Report From VISTA

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Incidence and Outcomes of Patients With Early Cardiac Complications After Intracerebral Hemorrhage: A Report From VISTA

Hironori Ishiguchi, MD https://orcid.org/0000-0003-4597-7862, Bi Huang, MD https://orcid.org/0000-0002-1763-8452, Wahbi K. El-Bouri, PhD https://orcid.org/0000-0002-2732-5927, Jesse Dawson, MD https://orcid.org/0000-0001-7532-2475, Gregory Y.H. Lip, MD https://orcid.org/0000-0002-7566-1626, and Azmil H. Abdul-Rahim, MD https://orcid.org/0000-0002-1318-4027 azmil.abdul-rahim@liverpool.ac.uk on behalf of the VISTA CollaboratorsAuthor Info & Affiliations

Stroke

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https://doi.org/10.1161/STROKEAHA.124.048189

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Abstract

BACKGROUND:

The incidence and outcomes of early cardiac complications in patients with intracerebral hemorrhage (ICH) are poorly understood. These cardiac complications may be part of the so-called stroke-heart syndrome in patients with ICH. We investigated this issue in an individual patient data pooled analysis from an international repository of clinical trial data.

METHODS:

We used the Virtual International Stroke Trials Archive to investigate the incidence of cardiac complications within 30 days post-ICH or acute ischemic stroke (AIS). These complications included acute coronary syndrome encompassing myocardial injury, heart failure/left ventricular dysfunction, atrial fibrillation/atrial flutter, other arrhythmia/ECG abnormalities, and cardiorespiratory arrest. We used propensity score matching to compare the incidence of patients with stroke-heart syndrome in patients with ICH with those following AIS. Factors associated with 90-day mortality were evaluated using multivariate logistic regression analysis in the ICH cohort.

RESULTS:

We pooled data from 8698 participants recruited in acute stroke trials (mean age, 68±12 years; 56% male), of whom 914 (11%) were patients with ICH. Among the patients with ICH, 123 (13%) had stroke-heart syndrome in patients with ICH. Following propensity score matching, a total of 1828 patients (914 for each of the cohorts) were analyzed. While the overall incidence of cardiac events tended to be lower in the ICH group compared with the AIS group (the cumulative incidence freedom from the event, 86.3% [95% CI, 84.1–88.6] versus 83.6% [95% CI, 81.2–86.0]; P=0.100), the incidences cardiac events other than atrial fibrillation/atrial flutter were comparable between the 2 matched groups. The incidence of atrial fibrillation/atrial flutter was significantly lower in the ICH group than in the AIS group (P<0.001). The multivariate-adjusted analysis found that stroke-heart syndrome in patients with ICH was associated with 90-day mortality (adjusted odds ratio, 1.12 [95% CI, 1.06–1.19]; P<0.001).

CONCLUSIONS:

Cardiac events are common and negatively affect prognosis in patients with ICH, just as seen in AIS.

Graphical Abstract

Heart complications after ischemic stroke increase risk of future cardiovascular events: Study

 

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Heart complications after ischemic stroke increase risk of future cardiovascular events: Study

ANI

1 April, 2022 07:00 pm IST

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Dallas (Texas) [US], April 1 (ANI): A recent study has found that heart complications within one month after an ischemic stroke may put stroke survivors at an increased risk for death, heart attack or another stroke within five years.

The study was published in the journal, ‘Stroke’.

Ischemic stroke is the most common type of stroke which blocks blood flow to the brain. After a stroke, people often have cardiovascular complications, known as a stroke-heart syndrome.

Heart complications include acute coronary syndrome, angina (chest pain), heart rhythm issues such as atrial fibrillation, arrhythmia and ventricular fibrillation; heart attack; heart failure or Takotsubo syndrome (broken heart syndrome), a type of stress-induced temporary enlargement of a part of the heart that impacts its ability to pump effectively. These conditions increase the risk of disability or death in the short term, yet the long-term consequences for people with the stroke-heart syndrome are unknown.

“We know heart disease and stroke share similar risk factors, and there’s a two-way relationship between the risk of stroke and heart disease. For example, heart conditions such as atrial fibrillation increase the risk of stroke, and stroke also increases the risk of heart conditions,” said Benjamin J.R. Buckley, PhD, lead author of the study and a postdoctoral research fellow in preventive cardiology at the Liverpool Centre for Cardiovascular Science, the University of Liverpool in the United Kingdom.

“We wanted to know how common newly diagnosed heart complications are after a stroke and, importantly, whether the stroke-heart syndrome is associated with increased risk of long-term major adverse events,” he added.

Researchers analyzed the medical records of more than 365,000 adults treated for ischemic stroke at more than 50 health care sites predominantly in the United States, between 2002 and 2021. People who were diagnosed with stroke-heart complications within four weeks after a stroke were matched to an equal number of stroke survivors who did not have these heart complications within four weeks (the control group).

After adjusting for potential confounding factors, such as age, sex and race/ethnicity, and comparing the stroke survivors who had new heart complications to those who did not, the analysis found:

1. Overall, among all stroke survivors in the study, about 1 in 10 (11.1 per cent) developed acute coronary syndrome, 8.8 per cent were diagnosed with atrial fibrillation, 6.4 per cent developed heart failure, 1.2 per cent exhibited severe ventricular arrhythmias and 0.1 per cent developed ‘broken heart’ syndrome within four weeks after the stroke.

2. Risk of death within five years after a stroke significantly increased among the participants with new heart complications. 49 per cent more likely if they had developed the acute coronary syndrome. 45 per cent more likely if they had developed atrial fibrillation/flutter and 83 per cent more likely if they developed heart failure. Severe ventricular arrhythmias doubled the risk of death.

3. The chance of hospitalization and heart attack within five years after a stroke was also significantly higher among those who developed heart complications within the one-month window.

4. Stroke survivors with Takotsubo syndrome were 89 per cent more likely to have a major heart event within the five years after their stroke.

5. People who developed atrial fibrillation after a stroke were 10 per cent more likely to have a second stroke within five years after their stroke.

6. People with stroke and newly diagnosed cardiovascular complications were 50 per cent more likely to have a recurrent stroke within five years after the first stroke.

“I was particularly surprised by how common stroke-heart syndrome was and the high rate of recurrent stroke in all subgroups of adults with the stroke-heart syndrome,” Buckley said.

“This means that this is a high-risk population where we should focus more secondary prevention efforts,” he added.

The study’s results build on the understanding of the two-way link between the brain and the heart and extend this understanding to long-term health outcomes. “We are working on additional research to determine how stroke-heart syndrome may be better predicted,” Buckley said.

“We also need to develop and implement treatments to improve outcomes for people with the stroke-heart syndrome,” Buckley said.

“For example, comprehensive exercise-based rehabilitation may be helpful after a stroke, so for people with stroke and newly developed heart complications, it should also be beneficial, maybe even more so. I think this is an interesting area for future research,” he added.

Study limitations have included that it is a retrospective analysis and knowing whether the heart complications diagnosed following an ischemic stroke were caused by stroke or rather contributed to the stroke, is unclear.

“This research underscores why it’s so important for neurologists and cardiologists to work hand-in-hand with their patients and each other to understand why the first stroke occurred and perform a comprehensive assessment to identify new risk factors for another stroke and for cardiovascular disease that may require initiation of prevention therapies,” said Lee H. Schwamm, M.D., volunteer chair of the American Stroke Association Advisory Committee and the C. Miller Fisher Chair in Vascular Neurology at Massachusetts General Hospital in Boston.

“The American Stroke Association recommends a personalized secondary stroke prevention plan for every stroke survivor,” he concluded. (ANI)

This report is auto-generated from ANI news service. ThePrint holds no responsibility for its content.

 

‘Stroke-heart syndrome’ increases 5-year risk for CV events, death

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‘Stroke-heart syndrome’ increases 5-year risk for CV events, death

By Regina Schaffer

Source/Disclosures

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New-onset CV complications after ischemic stroke predicts worse 5-year prognosis for major adverse CV events, including death, according to new research published in Stroke.

In an analysis of more than 360,000 patient medical records, researchers also found that patients with a newly diagnosed CV complication within 4 weeks of an ischemic stroke were 50% more likely to experience recurrent stroke at 5-year follow-up.

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“We know heart disease and stroke share similar risk factors, and there’s a two-way relationship between the risk of stroke and heart disease. For example, heart conditions such as atrial fibrillation increase the risk of stroke, and stroke also increases the risk of heart conditions,” Benjamin J.R. Buckley, PhD, a postdoctoral research fellow in preventive cardiology at the Liverpool Centre for Cardiovascular Science, University of Liverpool, U.K., said in a press release. “We wanted to know how common newly diagnosed heart complications are after a stroke and, importantly, whether stroke-heart syndrome is associated with increased risk of long-term major adverse events.”

In a retrospective study, Buckley and colleagues analyzed electronic medical records data from 365,383 patients with ischemic stroke and 5 years of follow-up, using data from 53 participating health care organizations. Researchers propensity score-matched patients with who were diagnosed with new-onset CV complications (HF, severe ventricular arrhythmia, AF, ischemic heart disease, Takotsubo syndrome) within 4 weeks of the incident ischemic stroke with patients who had a stroke but were not diagnosed with new-onset complications (controls), based on age, sex, race, comorbidities and CV care.

Within the cohort, 11.1% developed ACS; 8.8% developed AF/flutter; 6.4% developed HF; 1.2% developed severe ventricular arrythmias; and 0.1% developed Takotsubo syndrome within 4 weeks of the incident stroke.

After propensity score matching, odds for 5-year all-cause mortality were higher among patients with stroke who developed ACS (OR = 1.49; 95% CI, 1.44-1.54), AF/flutter (OR = 1.45; 95% CI, 1.4-1.5), HF (OR = 1.83; 95% CI, 1.76-1.91), and severe ventricular arrhythmias (OR = 2.08; 95% CI, 1.9-2.29) compared with controls.

Odds for 5-year rehospitalization and acute MI were also higher for patients with stroke diagnosed with new-onset CV complications. Takotsubo syndrome was associated with significantly higher odds for 5-year composite major adverse CV events, defined as death, hospitalization, recurrent stroke and acute MI (OR = 1.89; 95% CI, 1.29-2.77). AF/flutter was the only new-onset cardiac complication associated with significantly higher odds for recurrent ischemic stroke at 5 years (OR = 1.1; 95% CI, 1.07-1.14).

“Most notably, distinguishing stroke-heart syndrome from (otherwise unknown) concomitant or preceding cardiovascular complications is challenging, and reverse causation may have impacted the results of this study,” the researchers wrote. “For example, whether the new-onset cardiovascular complications, diagnosed after ischemic stroke, were caused by stroke, or contributed to the stroke is unclear. Indeed, prospective research is needed to infer causation, albeit a challenging endeavor in a stroke population.”