Predictive Value of the Inflammatory Prognostic Index for Ischemic Stroke in Patients with HFpEF and Atrial Fibrillation

Abstract

Aim: This study aimed to evaluate the predictive value of the inflammatory prognostic index (IPI) for ischemic cerebrovascular events in patients with heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF). Material and Methods: A total of 1,286 patients with HFpEF and AF followed between 2020 and 2024 were retrospectively included. The primary endpoint was the occurrence of ischemic stroke during follow-up. The mean follow-up duration was 651 ± 167 days. IPI and CHA₂DS₂-VA scores were calculated. Cox regression, receiver operating characteristic (ROC), and Kaplan–Meier analyses were performed. Results: Ischemic stroke occurred in 67 patients (5.2%). Patients with stroke were older and had higher rates of hypertension, coronary artery disease, and prior stroke/TIA, while oral anticoagulant use was lower. They also exhibited higher creatinine, CRP, and neutrophil levels and lower lymphocyte counts. Both IPI and CHA₂DS₂-VA scores were significantly higher in the stroke group. In multivariable analysis, creatinine (HR: 1.828), CHA₂DS₂-VA (HR: 2.081), and IPI (HR: 1.909) remained independent predictors of stroke. ROC analysis showed that IPI had superior discriminative ability compared to CHA₂DS₂-VA (AUC: 0.783 vs. 0.726). Kaplan–Meier analysis demonstrated a significantly higher incidence of stroke in patients with elevated IPI levels (log-rank p<0.001). Conclusion: IPI is a strong and independent predictor of ischemic stroke in patients with HFpEF and AF. Integration of inflammation-based biomarkers into conventional clinical risk scores may improve risk stratification, particularly in high-risk populations.

Keywords

• Atrial fibrillation
• HFpEF
• Inflammatory prognostic index
• Ischemic stroke

References

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