Sung-Min Cho1,2, Nader Moazami3,4, Stuart Katz5, Adarsh Bhimraj6, Nabin K Shrestha6, Jennifer A Frontera7,8,9. 1. Departments of Neurology, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 2. Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA. 3. Cardiothoracic Surgery (NM), NYU School of Medicine, New York, NY, USA. 4. Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA. 5. Department of Cardiology, NYU School of Medicine, New York, NY, USA. 6. Department of Infectious Disease, Cleveland Clinic, Cleveland, OH, USA. 7. Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA. jennifer.frontera@nyulangone.org. 8. Department of Neurology, NYU School of Medicine, New York, NY, USA. jennifer.frontera@nyulangone.org. 9. NYU Department of Neurology, 150 55th St., Brooklyn, NY, 11231, USA. jennifer.frontera@nyulangone.org.
Abstract
BACKGROUND: Infection has been associated with stroke in patients with left ventricular assist devices (LVAD); however, little data exist on the timing, type and mortality impact of infection-related stroke. METHODS: Prospectively collected data of HeartMate II (N = 332) and HeartWare (N = 70) LVAD patients from a single center were reviewed. Only strokes (ischemic or hemorrhagic) that occurred within 6 weeks following a LVAD infection were considered in analyses. The association between LVAD infections (wound, pump pocket, driveline and/or bloodstream infection [BSI]), specific pathogens and ischemic and hemorrhagic strokes was evaluated using multivariable logistic regression analysis. The impact of infection-related stroke on cumulative survival was assessed using Kaplan-Meier analysis. RESULTS: Of 402 patients, LVAD infection occurred in 158 (39%) including BSI in 107 (27%), driveline infection in 67 (17%), wound infection in 31 (8%) and pump pocket infection in 24 (6%). LVAD infection-related stroke occurred in 20/158 (13%) patients in a median of 4 days (0-36 days) from documented infection. In multivariable analysis, ischemic stroke was associated with wound infection (aOR 9.0, 95% CI 2.4-34.0, P = 0.001) and BSI (aOR 7.7, 95% CI 0.9-66.0, P = 0.064), and hemorrhagic stroke was associated with BSI in 100% of cases (P = 0.01). There was no association with driveline or pump pocket infection. The cumulative survival rate among patients with infection-related stroke was significantly lower compared to those with LVAD infection but no stroke (log-rank P < 0.001). There was a trend toward shorter stroke-free survival among patients with LVAD infection. CONCLUSIONS: LVAD infections, particularly BSI, are significantly associated with stroke, and infection-related stroke conferred significantly lower cumulative survival.
BACKGROUND: Infection has been associated with stroke in patients with left ventricular assist devices (LVAD); however, little data exist on the timing, type and mortality impact of infection-related stroke. METHODS: Prospectively collected data of HeartMate II (N = 332) and HeartWare (N = 70) LVAD patients from a single center were reviewed. Only strokes (ischemic or hemorrhagic) that occurred within 6 weeks following a LVAD infection were considered in analyses. The association between LVAD infections (wound, pump pocket, driveline and/or bloodstream infection [BSI]), specific pathogens and ischemic and hemorrhagic strokes was evaluated using multivariable logistic regression analysis. The impact of infection-related stroke on cumulative survival was assessed using Kaplan-Meier analysis. RESULTS: Of 402 patients, LVAD infection occurred in 158 (39%) including BSI in 107 (27%), driveline infection in 67 (17%), wound infection in 31 (8%) and pump pocket infection in 24 (6%). LVAD infection-related stroke occurred in 20/158 (13%) patients in a median of 4 days (0-36 days) from documented infection. In multivariable analysis, ischemic stroke was associated with wound infection (aOR 9.0, 95% CI 2.4-34.0, P = 0.001) and BSI (aOR 7.7, 95% CI 0.9-66.0, P = 0.064), and hemorrhagic stroke was associated with BSI in 100% of cases (P = 0.01). There was no association with driveline or pump pocket infection. The cumulative survival rate among patients with infection-related stroke was significantly lower compared to those with LVAD infection but no stroke (log-rank P < 0.001). There was a trend toward shorter stroke-free survival among patients with LVAD infection. CONCLUSIONS: LVAD infections, particularly BSI, are significantly associated with stroke, and infection-related stroke conferred significantly lower cumulative survival.
Entities:
Keywords:
HeartMate II (HM II); HeartWare (HVAD); Hemorrhagic stroke; Infection; Ischemic stroke; Left ventricular assist device (LVAD); Stroke
Authors: Aaron Shoskes; Catherine Hassett; Aron Gedansky; Randall Carson Starling; Jerry D Estep; Michael Z Y Tong; Sung-Min Cho; Ken Uchino Journal: Neurocrit Care Date: 2022-04-12 Impact factor: 3.532
Authors: Melanie Kranzl; Martin Stoiber; Anne-Kristin Schaefer; Julia Riebandt; Dominik Wiedemann; Christiane Marko; Günther Laufer; Daniel Zimpfer; Heinrich Schima; Thomas Schlöglhofer Journal: Front Cardiovasc Med Date: 2021-12-16