Adrian D Wood1, Gurdeep S Mannu1, Allan B Clark1, Somsak Tiamkao1, Kannikar Kongbunkiat1, Joao H Bettencourt-Silva1, Kittisak Sawanyawisuth1, Narongrit Kasemsap1, Raphae S Barlas1, Mamas Mamas1, Phyo Kyaw Myint2. 1. From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (A.D.W., R.S.B., P.K.M.); Oxford University Hospitals NHS Trust, United Kingdom (G.S.M.); Norwich Medical School, University of East Anglia, Norwich, United Kingdom (A.B.C.); Neurology Division (S.T., K.K.) and Ambulatory Medicine Division (K.K., K.S., N.K.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; North-eastern Stroke Research Group, Khon Kaen University, Thailand (ST, NK); Clinical Informatics, Department of Medicine, University of Cambridge, United Kingdom (J.H.B.-S.); Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (M.M.); and Farr Institute, University of Manchester, United Kingdom (M.M.). 2. From the Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, United Kingdom (A.D.W., R.S.B., P.K.M.); Oxford University Hospitals NHS Trust, United Kingdom (G.S.M.); Norwich Medical School, University of East Anglia, Norwich, United Kingdom (A.B.C.); Neurology Division (S.T., K.K.) and Ambulatory Medicine Division (K.K., K.S., N.K.), Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand; North-eastern Stroke Research Group, Khon Kaen University, Thailand (ST, NK); Clinical Informatics, Department of Medicine, University of Cambridge, United Kingdom (J.H.B.-S.); Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (M.M.); and Farr Institute, University of Manchester, United Kingdom (M.M.). phyo.myint@abdn.ac.uk.
Abstract
BACKGROUND AND PURPOSE: Rheumatic valvular heart disease is associated with the increased risk of cerebrovascular events, although there are limited data on the prognosis of patients with rheumatic mitral valve disease (RMVD) after stroke. METHODS: We examined the association between RMVD and both serious and common cardiovascular and noncardiovascular (respiratory and infective) complications in a cohort of hospitalized stroke patients based in Thailand. Factors associated with in-hospital mortality were also explored. Data were obtained from a National Insurance Database. All hospitalized strokes between October 1, 2004, and January 31, 2013, were included in the current study. Characteristics and outcomes were compared for RMVD and non-RMVD patients. Logistic regression, propensity score matching, and multivariate models were used to assess study outcomes. RESULTS: In total, 594 681 patients (mean [SD] age=64 [14.5] years) with a diagnosis of stroke (ischemic=306 154; hemorrhagic=195 392; undetermined=93 135) were included in this study, of whom 5461 had RMVD. Results from primary analyses showed that after ischemic stroke, and controlling for potential confounding covariates, RMVD was associated (P<0.001) with increased odds for cardiac arrest (odds ratio [95% confidence interval]=2.13 [1.68-2.70]), shock (2.13 [1.64-2.77]), arrhythmias (1.70 [1.21-2.39]), respiratory failure (2.09 [1.87-2.33]), pneumonia (2.00 [1.81-2.20]), and sepsis (1.39 [1.19-1.63]). In hemorrhagic stroke patients, RMVD was associated with increased odds (fully adjusted model) for respiratory failure (1.26 [1.01-1.57]), and in patients with undetermined stroke, RMVD was associated with increased odds (fully adjusted analyses) for shock (3.00 [1.46-6.14]), respiratory failure (2.70 [1.91-3.79]), and pneumonia (2.42 [1.88-3.11]). CONCLUSIONS: RMVD is associated with the development of cardiac arrest, shock, arrhythmias, respiratory failure, pneumonia, and sepsis after acute stroke.
BACKGROUND AND PURPOSE: Rheumatic valvular heart disease is associated with the increased risk of cerebrovascular events, although there are limited data on the prognosis of patients with rheumatic mitral valve disease (RMVD) after stroke. METHODS: We examined the association between RMVD and both serious and common cardiovascular and noncardiovascular (respiratory and infective) complications in a cohort of hospitalized stroke patients based in Thailand. Factors associated with in-hospital mortality were also explored. Data were obtained from a National Insurance Database. All hospitalized strokes between October 1, 2004, and January 31, 2013, were included in the current study. Characteristics and outcomes were compared for RMVD and non-RMVD patients. Logistic regression, propensity score matching, and multivariate models were used to assess study outcomes. RESULTS: In total, 594 681 patients (mean [SD] age=64 [14.5] years) with a diagnosis of stroke (ischemic=306 154; hemorrhagic=195 392; undetermined=93 135) were included in this study, of whom 5461 had RMVD. Results from primary analyses showed that after ischemic stroke, and controlling for potential confounding covariates, RMVD was associated (P<0.001) with increased odds for cardiac arrest (odds ratio [95% confidence interval]=2.13 [1.68-2.70]), shock (2.13 [1.64-2.77]), arrhythmias (1.70 [1.21-2.39]), respiratory failure (2.09 [1.87-2.33]), pneumonia (2.00 [1.81-2.20]), and sepsis (1.39 [1.19-1.63]). In hemorrhagic stroke patients, RMVD was associated with increased odds (fully adjusted model) for respiratory failure (1.26 [1.01-1.57]), and in patients with undetermined stroke, RMVD was associated with increased odds (fully adjusted analyses) for shock (3.00 [1.46-6.14]), respiratory failure (2.70 [1.91-3.79]), and pneumonia (2.42 [1.88-3.11]). CONCLUSIONS: RMVD is associated with the development of cardiac arrest, shock, arrhythmias, respiratory failure, pneumonia, and sepsis after acute stroke.
Authors: Tiberiu A Pana; Adrian D Wood; Jesus A Perdomo-Lampignano; Somsak Tiamkao; Allan B Clark; Kannikar Kongbunkiat; Joao H Bettencourt-Silva; Kittisak Sawanyawisuth; Narongrit Kasemsap; Mamas A Mamas; Phyo K Myint Journal: Heart Asia Date: 2019-04-20
Authors: Tiberiu A Pana; Dana K Dawson; Mohamed O Mohamed; Fiona Murray; David L Fischman; Michael P Savage; Mamas A Mamas; Phyo K Myint Journal: J Am Heart Assoc Date: 2021-03-08 Impact factor: 5.501
Authors: Weronika A Szlachetka; Tiberiu A Pana; Somsak Tiamkao; Allan B Clark; Kannikar Kongbunkiat; Kittisak Sawanyawisuth; Joao H Bettencourt-Silva; Narongrit Kasemap; Mamas A Mamas; Phyo K Myint Journal: Glob Heart Date: 2020-02-06