Understanding risk factors and predictors for stroke subtypes in the ENDURANCE trials
| Autor: | Ken Uchino, Sung Min Cho, Nicholas Hiivala, Joseph G. Rogers, Palak Shah, Francis D. Pagani, Randall C. Starling, Jeffrey J. Teuteberg |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty medicine.medical_treatment Population 030204 cardiovascular system & hematology Risk Assessment 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine medicine Humans Ischemic Cerebrovascular Accident cardiovascular diseases 030212 general & internal medicine education Stroke Aged Heart Failure Transplantation education.field_of_study Vascular disease business.industry Middle Aged Left ventricular thrombus medicine.disease United States Ventricular assist device Heart failure Cardiology Female Surgery Heart-Assist Devices Morbidity Cardiology and Cardiovascular Medicine business Destination therapy |
| Zdroj: | The Journal of Heart and Lung Transplantation. 39:639-647 |
| ISSN: | 1053-2498 |
| DOI: | 10.1016/j.healun.2020.01.1330 |
| Popis: | Stroke is a devastating morbidity associated with left ventricular assist device (LVAD) support. We report a comprehensive analysis of stroke subtypes in the ENDURANCE destination therapy (DT) and ENDURANCE Supplemental (DT2) trials.Patients in the combined HeartWare LVAD (HVAD) cohorts of the DT and DT2 trials were included. Neurologic events included ischemic stroke (ischemic cerebrovascular accident [ICVA]), hemorrhagic stroke (hemorrhagic cerebrovascular accident [HCVA]), and transient ischemic attack (TIA). Peri-operative strokes were defined as occurring within 2 weeks of the implant.A total of 604 patients received an HVAD in the DT (n = 296) and DT2 (n = 308) trials. Over 2 years, 178 (29.5%) had at least 1 cerebrovascular accident (CVA). Forty-four (7.3%) had HCVAs, 116 (19.2%) had ICVAs, and 44 (7.3%) had TIAs. Thirty (5.0%) had peri-operative stroke. In multivariable analysis, sub-therapeutic international normalized ratio (INR) values were independently associated with peri-operative stroke. Supra- and/or sub-therapeutic INR values, peripheral vascular disease, and presence of left ventricular thrombus were independently associated with ICVA. No aspirin and supra- and/or sub-therapeutic INR values were independently associated with TIA. No aspirin, supra- and/or sub-therapeutic INR values, and prior stroke and/or TIA were associated with HCVA. In further analysis, mean arterial pressure (MAP) was higher in the ICVA (86.8mm Hg, p = 0.002 4) and TIA (88.8mm Hg, p0.0001) groups, but not in HCVA, than in the No-CVA group (81.4mm Hg). Time in therapeutic range for INR was 65.3% for the No-CVA group, 62.9% (p = 0.59) for HCVA, 65.1% (p = 0.97) for ICVA, and 63.2% (p = 0.62) for TIA.Supra- and sub-therapeutic INR values at the time of CVA were associated with all stroke subtypes14 days post-implant. MAP was higher among those with ICVA and TIA but not with HCVA compared to without CVA. Our study demonstrates the challenges of anti-thrombotic therapy and blood pressure management in LVAD population. |
| Databáze: | OpenAIRE |
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