Acute Ischemic Stroke, Depressed Left Ventricular Ejection Fraction, and Sinus Rhythm: Prevalence and Practice Patterns

被引：6

作者：

Baker, Anna D. ^{[1
]}

Schwamm, Lee H. ^{[3
,4
]}

Sanborn, Danita Y. ^{[5
,6
]}

Furie, Karen ^{[7
]}

Stretz, Christoph ^{[7
]}

Mac Grory, Brian ^{[9
]}

Yaghi, Shadi ^{[7
]}

Kleindorfer, Dawn ^{[10
,11
]}

Sucharew, Heidi ^{[12
]}

Mackey, Jason ^{[14
]}

Walsh, Kyle ^{[15
]}

Flaherty, Matt ^{[16
]}

Kissela, Brett ^{[16
]}

Alwell, Kathleen ^{[11
]}

Khoury, Jane ^{[13
]}

Khatri, Pooja ^{[16
]}

Adeoye, Opeolu ^{[17
]}

Ferioli, Simona ^{[16
]}

Woo, Daniel ^{[16
]}

Martini, Sharyl ^{[18
,19
]}

La Rosa, Felipe De Los Rios ^{[11
,20
]}

Demel, Stacie L. ^{[16
]}

Madsen, Tracy ^{[8
]}

Star, Michael ^{[21
]}

Coleman, Elisheva ^{[22
]}

Slavin, Sabreena ^{[23
]}

Jasne, Adam ^{[1
]}

Mistry, Eva A. ^{[24
]}

Haverbusch, Mary ^{[11
]}

Merkler, Alexander E. ^{[25
]}

Kamel, Hooman ^{[25
]}

Schindler, Joseph ^{[1
]}

Sansing, Lauren H. ^{[1
]}

Faridi, Kamil F. ^{[2
]}

Sugeng, Lissa ^{[2
]}

Sheth, Kevin N. ^{[1
]}

Sharma, Richa ^{[1
]}

机构：

[1] Yale Sch Med, Dept Neurol, New Haven, CT USA

[2] Yale Sch Med, Sect Cardiovasc Med, Dept Med, New Haven, CT USA

[3] Massachusetts Gen Hosp, Dept Neurol, Boston, MA 02114 USA

[4] Massachusetts Gen Hosp, Comprehens Stroke Ctr, Boston, MA USA

[5] Massachusetts Gen Hosp, Div Cardiol, Boston, MA USA

[6] Harvard Med Sch, Boston, MA 02115 USA

[7] Brown Univ, Dept Neurol, Alpert Med Sch, Providence, RI USA

[8] Brown Univ, Dept Emergency Med, Alpert Med Sch, Div Sex & Gender, Providence, RI USA

[9] Duke Univ, Dept Neurol, Sch Med, Durham, NC USA

[10] Univ Michigan, Dept Neurol, Sch Med, Ann Arbor, MI USA

[11] Univ Cincinnati, Dept Neurol, Cincinnati, OH USA

[12] Cincinnati Childrens Hosp Med Ctr, Dept Pediat, Div Biostat & Epidemiol, Cincinnati, OH USA

[13] Univ Cincinnati, Dept Pediat, Div Biostat & Epidemiol, Cincinnati Childrens Hosp Med Ctr,Med Ctr, Cincinnati, OH USA

[14] Indiana Univ Sch Med, Dept Neurol, Indianapolis, IN USA

[15] Univ Cincinnati, Dept Emergency Med, Gardner Neurosci Inst, Cincinnati, OH USA

[16] Univ Cincinnati, Dept Neurol & Rehab Med, Gardner Neurosci Inst, Cincinnati, OH USA

[17] Washington Univ, Dept Emergency Med, Sch Med, St Louis, MO USA

[18] Baylor Coll Med, Dept Neurol, Houston, TX 77030 USA

[19] VA Natl TeleStroke Program, Houston, TX USA

[20] Miami Neurosci Inst, Baptist Hlth South Florida, Miami, FL USA

[21] Soroka Med Ctr, Dept Neurol, Beer Sheva, Israel

[22] Northwestern Mem Hosp, Dept Neurol, Chicago, IL USA

[23] Univ Kansas, Med Ctr, Dept Neurol, Kansas City, KS 66103 USA

[24] Vanderbilt Univ, Dept Neurol, Med Ctr, Nashville, TN USA

[25] Weill Cornell Med, Dept Neurol, New York, NY USA

来源：

STROKE | 2022年 / 53卷 / 06期

关键词：

atrial fibrillation; echocardiograph; ischemic stroke; prevalence; CHRONIC HEART-FAILURE; RANDOMIZED-TRIAL; WARFARIN; ASPIRIN; THERAPY; RISK; DYSFUNCTION; GUIDELINES;

D O I：

10.1161/STROKEAHA.121.036706

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background: There are limited data about the epidemiology and secondary stroke prevention strategies used for patients with depressed left ventricular ejection fraction (LVEF) and sinus rhythm following an acute ischemic stroke (AIS). We sought to describe the prevalence of LVEF <= 40% and sinus rhythm among patients with AIS and antithrombotic treatment practice in a multi-center cohort from 2002 to 2018. Methods: This was a multi-center, retrospective cohort study comprised of patients with AIS hospitalized in the Greater Cincinnati Northern Kentucky Stroke Study and 4 academic, hospital-based cohorts in the United States. A 1-stage meta-analysis of proportions was undertaken to calculate a pooled prevalence. Univariate analyses and an adjusted multivariable logistic regression model were performed to identify demographic, clinical, and echocardiographic characteristics associated with being prescribed an anticoagulant upon AIS hospitalization discharge. Results: Among 14 338 patients with AIS with documented LVEF during the stroke hospitalization, the weighted pooled prevalence of LVEF <= 40% and sinus rhythm was 5.0% (95% CI, 4.1-6.0%; I-2, 84.4%). Of 524 patients with no cardiac thrombus and no prior indication for anticoagulant who survived postdischarge, 200 (38%) were discharged on anticoagulant, 289 (55%) were discharged on antiplatelet therapy only, and 35 (7%) on neither. There was heterogeneity by site in the proportion discharged with an anticoagulant (22% to 45%, P<0.0001). Cohort site and National Institutes of Health Stroke Severity scale >8 (odds ratio, 2.0 [95% CI, 1.1-3.8]) were significant, independent predictors of being discharged with an anticoagulant in an adjusted analysis. Conclusions: Nearly 5% of patients with AIS have a depressed LVEF and are in sinus rhythm. There is significant variation in the clinical practice of antithrombotic therapy prescription by site and stroke severity. Given this clinical equipoise, further study is needed to define optimal antithrombotic treatment regimens for secondary stroke prevention in this patient population.

引用

页码：1883 / 1891

页数：9

共 29 条

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