Risk of stroke in chronic heart failure patients with preserved ejection fraction, but without atrial fibrillation: analysis of the CHARM-Preserved and I-Preserve trials.
Risk of stroke in chronic heart failure patients with preserved ejection fraction, but without atrial fibrillation: analysis of the CHARM-Preserved and I-Preserve trials.
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DOI：
10.1093/eurheartj/ehw509
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发表时间：
2017-03-07
影响因子：
39.3
通讯作者：
Candesartan in Heart failure Assessment of Reduction in Mortality and Morbidity-Preserved (CHARM-Preserved) and the Irbesartan in Heart Failure with Preserved Systolic Function (I-Preserve) Steering Committees
中科院分区：
文献类型：
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作者：
Abdul-Rahim AH;Perez AC;MacIsaac RL;Jhund PS;Claggett BL;Carson PE;Komajda M;McKelvie RS;Zile MR;Swedberg K;Yusuf S;Pfeffer MA;Solomon SD;Lip GYH;Lees KR;McMurray JJV;Candesartan in Heart failure Assessment of Reduction in Mortality and Morbidity-Preserved (CHARM-Preserved) and the Irbesartan in Heart Failure with Preserved Systolic Function (I-Preserve) Steering Committees
有心力衰竭和射血分数保留(HF-PEF)但无房颤(AF)的患者卒中的发生率和预测因素尚不清楚。我们描述了有房颤和无房颤的HF-PEF患者的卒中发生率，以及没有房颤的患者的卒中预测因素。我们汇集了魅力保护试验和我保护试验的数据。使用COX回归，我们得出了该队列中无房颤患者的卒中模型，并与已发表的射血分数(HF-REF)降低的心力衰竭患者的模型进行了比较-预测变量：年龄、体重指数、纽约心脏协会分级、卒中病史和胰岛素治疗的糖尿病。对两种卒中模型进行了比较，并估算了卒中的Kaplan-Meier曲线。该风险模型在第三次HF-PEF试验中得到了验证。在6701名患者中，4676名患者没有房颤。发生卒中的有房颤124例(6.1%)，无房颤171例(3.7%)(每100人年分别为1.80和1.00)。当预测变量重叠时，在HF-PEF队列中得出的卒中模型和已发表的HF-REF模型的性能没有差异(c指数0.71，95%可信区间0.57-0.84对0.73，0.59-0.85)。该模型在验证队列中表现良好(0.86，0.62-0.99)。风险在前1/3的患者的卒中发生率与房颤患者相近(分别为每100人年1.60和1.80)。少数临床变量确定了一部分有HF-PEF但没有房颤的患者卒中风险较高。
The incidence and predictors of stroke in patients with heart failure and preserved ejection fraction (HF-PEF), but without atrial fibrillation (AF), are unknown. We described the incidence of stroke in HF-PEF patients with and without AF and predictors of stroke in those without AF. We pooled data from the CHARM-Preserved and I-Preserve trials. Using Cox regression, we derived a model for stroke in patients without AF in this cohort and compared its performance with a published model in heart failure patients with reduced ejection fraction (HF-REF)—predictive variables: age, body mass index, New York Heart Association class, history of stroke, and insulin-treated diabetes. The two stroke models were compared and Kaplan–Meier curves for stroke estimated. The risk model was validated in a third HF-PEF trial. Of the 6701 patients, 4676 did not have AF. Stroke occurred in 124 (6.1%) with AF and in 171 (3.7%) without AF (rates 1.80 and 1.00 per 100 patient-years, respectively). There was no difference in performance of the stroke model derived in the HF-PEF cohort and the published HF-REF model (c-index 0.71, 95% confidence interval 0.57–0.84 vs. 0.73, 0.59–0.85, respectively) as the predictive variables overlapped. The model performed well in the validation cohort (0.86, 0.62–0.99). The rate of stroke in patients in the upper third of risk approximated to that in patients with AF (1.60 and 1.80 per 100 patient-years, respectively). A small number of clinical variables identify a subset of patients with HF-PEF, but without AF, at elevated risk of stroke.