Prediction of long-term ischemic stroke with estimated whole blood viscosity in heart failure patients

Yıl 2024, Cilt: 5 Sayı: 1, 16 - 22, 29.02.2024

Duygu İnan , Aslan Erdoğan

https://doi.org/10.47582/jompac.1416037

Öz

Aims: Heart failure (HF) and stroke often coexist and share common risk factors, including atrial fibrillation. Whole blood viscosity (WBV), one of the most significant indicators of endothelial stress, is a fundamental determinant of blood flow and is involved in the aetiology of atherosclerosis and thrombosis. The purpose of this study was to assess the association between estimated WBV and long-term ischemic stroke (IS) risk in patients hospitalized for acute HF.
Methods: A total of 409 patients with reduced ejection fraction HF hospitalized with acute HF were included. The primary outcome was IS post-discharge follow-up.
Results: IS occurred in 26 (6%) patients during a follow-up. In the IS group, older age, diabetes mellitus frequency and WBV were higher, left ventricular end-diastolic and left atrial anteroposterior diameter were increased and left ventricular ejection fraction was lower. In multivariate regression analysis, WBV was found to be a predictor of long-term IS (OR, 2.68; 95% CI, 1.96-3.12, p=0.008). In the receiver operating characteristic curve, the optimal cut-off value of WBV for one-year IS was 6.28 with 61.5% sensitivity and 70.2% specificity (area under the curve: 0.748).
Conclusion: WBV is a novel, easily measurable, cost-effective, non-invasive risk marker for the prediction of long-term IS in patients with HF, independent of traditional risk factors.

Anahtar Kelimeler

Heart failure, ischemic stroke, whole blood viscosity

Kalp yetmezliği hastalarında tahmini tam kan viskozitesi ile uzun vadeli iskemik inmenin öngörülmesi

Öz

Amaç: Kalp yetmezliği (KY) ve inme sıklıkla bir arada bulunur ve atriyal fibrilasyon gibi ortak risk faktörlerini paylaşır. Endotel stresinin en önemli göstergelerinden biri olan tam kan viskozitesi (WBV), kan akışının temel bir belirleyicisidir, ateroskleroz ve tromboz etiyolojisinde rol oynar. Bu çalışmanın amacı, akut KY nedeniyle hastaneye yatırılan hastalarda tahmini WBV ile uzun vadeli iskemik strok (IS) riski arasındaki ilişkiyi değerlendirmektir.
Yöntemler: Akut KY nedeniyle hastaneye yatırılan ejeksiyon fraksiyonu düşük toplam 409 hasta çalışmaya dahil edildi. Birincil sonuç taburculuk sonrası takipte İS gelişimidir.
Sonuçlar: Takip süresince 26 (%6) hastada İS meydana geldi. İS grubunda ileri yaş, diabetes mellitus daha sık ve WBV daha yüksek, sol ventrikül diyastol sonu ve sol atriyum ön-arka çapı artmış ve sol ventrikül ejeksiyon fraksiyonu daha düşüktü. Çok değişkenli regresyon analizinde, WBV uzun dönem İS'nin bir ön gördürücüsü olarak tespit edilmiştir(OR, 2.68; %95 GA, 1.96 - 3.12, p=0.008). Alıcı işletim karakteristik eğrisinde, bir yıllık İS için WBV'nin optimal kesme değeri %61,5 duyarlılık ve %70,2 özgüllük ile 6,28 idi (eğri altındaki alan: 0,748).
Sonuç: WBV, geleneksel risk faktörlerinden bağımsız olarak KY hastalarında uzun vadeli İS'nin öngörülmesi için yeni, kolay ölçülebilir, maliyet etkin, invazif olmayan bir risk belirtecidir.

Anahtar Kelimeler

iskemik inme, tam kan viskozitesi, kalp yetersizliği

Kaynakça

• Vos T, Allen C, Arora M, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1545-1602.
• Feigin VL, Norrving B, Mensah GA. Global burden of stroke. Circ Res. 2017;120(3):439-448.
• McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-3726.
• Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am College Cardiol. 2022;79(17):e263-e421.
• Pullicino PM, McClure LA, Wadley VG, et al. Blood pressure and stroke in heart failure in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Stroke. 2009;40(12):3706-3710.
• Kannel WB, Wolf PA, Verter J. Manifestations of coronary disease predisposing to stroke. The Framingham study. JAMA. 1983;250(21):2942-2946.
• Witt BJ, Brown RD Jr, Jacobsen SJ, et al. Ischemic stroke after heart failure: a community-based study. Am Heart J. 2006;152(1):102-109.
• Kang SH, Kim J, Park JJ, et al. Risk of stroke in congestive heart failure with and without atrial fibrillation. Int J Cardiol. 2017;248:182-187.
• Adelborg K, Szepligeti S, Sundboll J, et al. Risk of stroke in patients with heart failure: a population-based 30-year cohort study. Stroke. 2017;48(5):1161-1168.
• Alberts VP, Bos MJ, Koudstaal P, et al. Heart failure and the risk of stroke: the Rotterdam Study. Eur J Epidemiol. 2010;25(11):807-812.
• de Simone G, Devereux RB, Chien S, Alderman MH, Atlas SA, Laragh JH. Relation of blood viscosity to demographic and physiologic variables and to cardiovascular risk factors in apparently normal adults. Circulation. 1990;81(1):107-117.
• Cho DJ. Blood viscosity abnormalities in large and small vessel diseases: future directions for plasma medicine. Plasma Med. 2012;2(4):221-235.
• Grotemeyer KC, Kaiser R, Grotemeyer KH, Husstedt IW. Association of elevated plasma viscosity with small vessel occlusion in ischemic cerebral disease. Thromb Res. 2014;133(1):96-100.
• Cagli EK, Gurel IE, Ozeke O, et al. Blood viscosity changes in slow coronary flow patients. Clin Hemorheol Microcirc. 2011;47(1):27-35.
• Tamariz LJ, Young JH, Pankow JS, et al. Blood viscosity and hematocrit as risk factors for type 2 diabetes mellitus: the atherosclerosis risk in communities (ARIC) study. Am J Epidemiol. 2008;168(10):1153-1160.
• Özcan Çetin EH, Çetin MS, Çağlı K, et al. The association of estimated whole blood viscosity with hemodynamic parameters and prognosis in patients with heart failure. Biomark Med. 2019;13(02):69-82.
• Brämer GR. International statistical classification of diseases and related health problems. Tenth revision. World Health Stat Q. 1988;41(1):32-36.
• Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5):373-498
• Kleindorfer DO, Towfighi A, Chaturvedi Seemant, et al. 2021 Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association. Stroke. 2021;52(7):e364-e467.
• Mitchell C, Rahko PS, Blauwet LA, et al. Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2019; 32(1):1-64.
• Pullicino P, Homma S. Stroke in heart failure: atrial fibrillation revisited? J Stroke Cerebrovasc Dis. 2010;19(1):1-2.
• Haeusler KG, Laufs U, Endres M. Chronic heart failure and ischemic stroke. Stroke. 2011;42(10):2977-2982.
• Loh E, Sutton MS, Wun CC, et al. Ventricular dysfunction and the risk of stroke after myocardial infarction. N Engl J Med. 1997;336(4):251-257.
• Witt BJ, Gami AS, Ballman KV, et al. The incidence of ischemic stroke in chronic heart failure: a meta-analysis. J Card Fail. 2007;13(6):489-496.
• Zhou H, Xu T, Huang Y, et al. The top tertile of hematocrit change during hospitalization is associated with lower risk of mortality in acute heart failure patients. BMC Cardiovasc Disord. 2017;17(1):235.