Open AccessA novel risk model to predict first-ever ischemic stroke in heart failure with reduced ejection fraction
Author(s) -
Xiaodong Zhou,
Lingfang Yu,
Wenlong Hu,
Ruiyu Shi,
Yinan Ji,
Changzuan Zhou,
Chenglong Xue,
Guojia Yu,
Weijian Huang,
Peiren Shan
Publication year - 2021
Publication title -
aging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.473
H-Index - 90
ISSN - 1945-4589
DOI - 10.18632/aging.202458
Subject(s) - medicine , cardiology , nomogram , atrial fibrillation , stroke (engine) , ejection fraction , heart failure , thrombus , framingham risk score , left ventricular thrombus , proportional hazards model , ischemic stroke , ischemia , disease , mechanical engineering , engineering
Patients with heart failure are at increased risk for ischemic stroke. We aim to develop a more accurate stroke risk prediction tools identify high-risk patients with heart failure with reduced ejection fraction (HFrEF). Patient data were extracted retrospectively from the electronic medical database between January 2009 and February 2019. Univariate and multivariate Cox regression analysis were performed to identify independent predictors, which were utilized to construct a nomogram for predicting ischemic stroke. AUROC analysis was used to compare the prognostic value between the new risk score and CHADS 2 /CHA 2 DS 2 -VASc scores. In 6087 patients with HFrEF, the risk of first-ever ischemic stroke was 5.8% events/pts-years (n=468) during 8007.2 person-years follow-up. A nomogram constructed by integrating 6 variables, including age, atrial fibrillation (AF), deep vein thrombosis (DVT), d-dimer, anticoagulant use and spontaneous echocardiographic contrast (SEC)/left ventricular thrombus (LVT), exhibited a greater area under the curve of 0.727, 0.728 and 0.714 than that by CHADS 2 score (0.515, 0.522 and 0.540), and by CHA 2 DS 2 -VASc score (0.547, 0.553 and 0.562) for predicting first-ever ischemic stroke at hospitalization, 30-day and 6-month follow-up (all p<0.001). This novel stroke risk score performed better than existing CHADS 2 / CHA 2 DS 2 -VASc scores and showed improvement in predicting first-ever ischemic stroke in HFrEF patients.