Yi Li1, Timothy P Fitzgibbons2, David D McManus3, Richard P Goddeau4, Brian Silver5, Nils Henninger6. 1. Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts. Electronic address: lyi@stanford.edu. 2. Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts. Electronic address: Timothy.Fitzgibbons@umassmed.edu. 3. Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts. Electronic address: David.McManus@umassmed.edu. 4. Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts. Electronic address: Richard.Goddeau@umassmemorial.org. 5. Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts. Electronic address: Brian.Silver@umassmemorial.org. 6. Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts. Electronic address: nils.henninger@umassmed.edu.
Abstract
BACKGROUND: Heart failure (HF) is a risk factor for atrial fibrillation (AF), stroke, and post-stroke disability. However, differing definitions and application of HF-criteria may impact model prediction. We compared the predictive ability of left ventricular ejection fraction (LVEF), a readily available objective echocardiographic index, with clinical HF definitions for functional disability and AF in stroke patients. METHODS: We retrospectively analyzed ischemic stroke patients evaluated between January 2013 and May 2015. Outcomes of interest were: (a) 90-day functional disability (modified Rankin score 3-6) and (b) AF. We compared: (1) LVEF (continuous variable), (2) left ventricular systolic dysfunction (LVSD)-categories (absent to severe), (3) clinical history of HF, and (4) HF/LVSD-categories: (i) HF absent without LVSD, (ii) HF absent with LVSD, (iii) HF with preserved ejection fraction (HFpEF), and (iv) HF with reduced ejection fraction (HFrEF). Multivariable logistic regression was used to determine the predictive ability for 90-day disability and AF, respectively. RESULTS: Six hundred eighty five consecutive patients (44.5% female) fulfilled the study criteria and were included. After adjustment, the LVEF was independently associated with 90-day disability (OR .98, 95% CI .96-.99, P = .011) with similar predictive ability (area under the curve [AUC] = .85) to models including the LVSD-categories (AUC = .85), clinically define HF (AUC = .86), and HF/LVSD-categories (AUC = .86). The LVEF, HF, LVSD-, and HF/LVSD-categories were independently associated with AF (P < .01, each) with similar predictive ability (AUC = .74, .74, .73, and .75, respectively). CONCLUSIONS: Compared to commonly defined HF definitions, the objectively determined LVEF possesses comparable predictive ability for 90-day disability and AF in stroke patients.
BACKGROUND:Heart failure (HF) is a risk factor for atrial fibrillation (AF), stroke, and post-stroke disability. However, differing definitions and application of HF-criteria may impact model prediction. We compared the predictive ability of left ventricular ejection fraction (LVEF), a readily available objective echocardiographic index, with clinical HF definitions for functional disability and AF in strokepatients. METHODS: We retrospectively analyzed ischemic strokepatients evaluated between January 2013 and May 2015. Outcomes of interest were: (a) 90-day functional disability (modified Rankin score 3-6) and (b) AF. We compared: (1) LVEF (continuous variable), (2) left ventricular systolic dysfunction (LVSD)-categories (absent to severe), (3) clinical history of HF, and (4) HF/LVSD-categories: (i) HF absent without LVSD, (ii) HF absent with LVSD, (iii) HF with preserved ejection fraction (HFpEF), and (iv) HF with reduced ejection fraction (HFrEF). Multivariable logistic regression was used to determine the predictive ability for 90-day disability and AF, respectively. RESULTS: Six hundred eighty five consecutive patients (44.5% female) fulfilled the study criteria and were included. After adjustment, the LVEF was independently associated with 90-day disability (OR .98, 95% CI .96-.99, P = .011) with similar predictive ability (area under the curve [AUC] = .85) to models including the LVSD-categories (AUC = .85), clinically define HF (AUC = .86), and HF/LVSD-categories (AUC = .86). The LVEF, HF, LVSD-, and HF/LVSD-categories were independently associated with AF (P < .01, each) with similar predictive ability (AUC = .74, .74, .73, and .75, respectively). CONCLUSIONS: Compared to commonly defined HF definitions, the objectively determined LVEF possesses comparable predictive ability for 90-day disability and AF in strokepatients.
Authors: Denise Battaglini; Chiara Robba; Adriana Lopes da Silva; Cynthia Dos Santos Samary; Pedro Leme Silva; Felipe Dal Pizzol; Paolo Pelosi; Patricia Rieken Macedo Rocco Journal: Crit Care Date: 2020-04-21 Impact factor: 9.097
Authors: Peter U Heuschmann; Felipe A Montellano; Kathrin Ungethüm; Viktoria Rücker; Silke Wiedmann; Daniel Mackenrodt; Anika Quilitzsch; Timo Ludwig; Peter Kraft; Judith Albert; Caroline Morbach; Stefan Frantz; Stefan Störk; Karl Georg Haeusler; Christoph Kleinschnitz Journal: ESC Heart Fail Date: 2020-12-22