Journal of Cardiac Failure
Volume 13, Issue 6 , Pages 489-496 , August 2007

The Incidence of Ischemic Stroke in Chronic Heart Failure: A Meta-Analysis

  • Brandi J. Witt, MD

      Affiliations

    • From the Division of Cardiovascular Diseases, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, Minnesota
    • ,
  • Apoor S. Gami, MD

      Affiliations

    • From the Division of Cardiovascular Diseases, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, Minnesota
    • ,
  • Karla V. Ballman, PhD

      Affiliations

    • Division of Biostatistics, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, Minnesota
    • ,
  • Robert D. Brown Jr., MD, MPH

      Affiliations

    • Department of Neurology, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, Minnesota
    • ,
  • Ryan A. Meverden, BS

      Affiliations

    • Division of Biostatistics, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, Minnesota
    • ,
  • Stephen J. Jacobsen, MD

      Affiliations

    • Director of Research, Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California
    • ,
  • Véronique L. Roger, MD, MPH

      Affiliations

    • From the Division of Cardiovascular Diseases, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, Minnesota
    • Division of Epidemiology, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, Minnesota
    • Corresponding Author InformationReprint requests: VL Roger, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Received 27 July 2006 ,Revised 23 January 2007 ,Accepted 26 January 2007.

References 

  1. American Heart Association. Heart disease and stroke statistics—2005 update. Available at: www.americanheart.org, 2005.
  2. Roger VL, Weston SA, Redfield MM, et al. Trends in heart failure incidence and survival in a community-based population. JAMA. 2004;292:344–350
  3. Hunt S, Abraham W, Chin M, et al. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2005;112:e154–e235
  4. Maisel WH, Stevenson LW. Atrial fibrillation in heart failure: epidemiology, pathophysiology, and rationale for therapy. Am J Cardiol. 2003;91:2D–8D
  5. Fuster V, Ryden L, Cannom D, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines. J Am Coll Cardiol. 2006;48:e149–e246
  6. Walsh MN, Prystowsky EN. Anti-thrombotic strategies for patients with atrial fibrillation and heart failure. Heart Failure Rev. 2002;7:261–266
  7. Cioffi G, Pozzoli M, Forni G, et al. Systemic thromboembolism in chronic heart failure. A prospective study in 406 patients. Eur Heart J. 1996;17:1381–1389
  8. Crawford TC, Smith WT, Velazquez EJ, Taylor SM, Jollis JG, Kisslo J. Prognostic usefulness of left ventricular thrombus by echocardiography in dilated cardiomyopathy in predicting stroke, transient ischemic attack, and death. [see comment] Am J Cardiol. 2004;93:500–503
  9. Maron MS, Olivotto I, Betocchi S, et al. Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy. [see comment] N Engl J Med. 2003;348:295–303
  10. Leizorovicz A, Lechat P, Cucherat M, Bugnard F. Bisoprolol for the treatment of chronic heart failure: a meta-analysis on individual data of two placebo-controlled studies—CIBIS and CIBIS II. Cardiac Insufficiency Bisoprolol Study. Am Heart J. 2002;143:301–307
  11. Pullicino PM, Halperin JL, Thompson JL. Stroke in patients with heart failure and reduced left ventricular ejection fraction. Neurology. 2000;54:288–294
  12. Dries DL, Rosenberg YD, Waclawiw MA, Domanski MJ. Ejection fraction and risk of thromboembolic events in patients with systolic dysfunction and sinus rhythm: evidence for gender differences in the studies of left ventricular dysfunction trials. [erratum appears in J Am Coll Cardiol 1998;32:555] J Am Coll Cardiol. 1997;29:1074–1080
  13. Kyrle PA, Korninger C, Gossinger H, et al. Prevention of arterial and pulmonary embolism by oral anticoagulants in patients with dilated cardiomyopathy. Thromb Haemost. 1985;54:521–523
  14. Loh E, Sutton MS, Wun CC, et al. Ventricular dysfunction and the risk of stroke after myocardial infarction. [see comment] N Engl J Med. 1997;336:251–257
  15. Fang MC, Chang Y, Hylek EM, et al. Advanced age, anticoagulation intensity, and risk for intracranial hemorrhage among patients taking warfarin for atrial fibrillation. [see comment] [summary for patients in Ann Intern Med 2004;141:I38; PMID: 15545670] Ann Intern Med. 2004;141745–141752
  16. Ciaccheri M, Castelli G, Cecchi F, et al. Lack of correlation between intracavitary thrombosis detected by cross sectional echocardiography and systemic emboli in patients with dilated cardiomyopathy. Br Heart J. 1989;62:26–29
  17. Fuster V, Gersh BJ, Giuliani ER, Tajik AJ, Brandenburg RO, Frye RL. The natural history of idiopathic dilated cardiomyopathy. Am J Cardiol. 1981;47:525–531
  18. Blondheim DS, Jacobs LE, Kotler MN, Costacurta GA, Parry WR. Dilated cardiomyopathy with mitral regurgitation: decreased survival despite a low frequency of left ventricular thrombus. Am Heart J. 1991;122:763–771
  19. Gottdiener JS, Gay JA, VanVoorhees L, DiBianco R, Fletcher RD. Frequency and embolic potential of left ventricular thrombus in dilated cardiomyopathy: assessment by 2-dimensional echocardiography. Am J Cardiol. 1983;52:1281–1285
  20. Falk RH, Foster E, Coats MH. Ventricular thrombi and thromboembolism in dilated cardiomyopathy: a prospective follow-up study. Am Heart J. 1992;123:136–142
  21. Kalaria VG, Passannante MR, Shah T, Modi K, Weisse AB. Effect of mitral regurgitation on left ventricular thrombus formation in dilated cardiomyopathy. [see comment] Am Heart J. 1998;135:215–220
  22. Natterson PD, Stevenson WG, Saxon LA, Middlekauff HR, Stevenson LW. Risk of arterial embolization in 224 patients awaiting cardiac transplantation. Am Heart J. 1995;129:564–570
  23. Dunkman WB, Johnson GR, Carson PE, Bhat G, Farrell L, Cohn JN. Incidence of thromboembolic events in congestive heart failure. The V-HeFT VA Cooperative Studies Group. Circulation. 1993;87(Suppl):VI94–VI101
  24. Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). The CONSENSUS Trial Study Group. N Engl J Medic. 1987;316:1429–1435
  25. Anonymous. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. The SOLVD Investigators. [see comment] New England Journal of Medicine. Aug 1 1991;325(5):293–302
  26. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. [see comment] Lancet. 1993;342:821–828
  27. Andersson B, Waagstein F. Spectrum and outcome of congestive heart failure in a hospitalized population. Am Heart J. 1993;126:632–640
  28. Gottdiener JS, McClelland RL, Marshall R, et al. Outcome of congestive heart failure in elderly persons: influence of left ventricular systolic function. The Cardiovascular Health Study. [summary for patients in Ann Intern Med 2002;137:I26; PMID: 12379095] Ann Intern Med. 2002;137:631–639
  29. Jelinek MV, Ansari MZ. Congestive cardiac failure (CCF) as a cause of fatal stroke and all cause death. Aust N Z J Med. 1998;28:799–804
  30. Katz SD, Marantz PR, Biasucci L, et al. Low incidence of stroke in ambulatory patients with heart failure: a prospective study. Am Heart J. 1993;126:141–146
  31. Sharma ND, McCullough PA, Philbin EF, Weaver WD. Left ventricular thrombus and subsequent thromboembolism in patients with severe systolic dysfunction. Chest. 2000;117:314–320
  32. Brown RD, Whisnant JP, Sicks JD, O'Fallon WM, Wiebers DO. Stroke incidence, prevalence, and survival: secular trends in Rochester, Minnesota, through 1989. Stroke. 1996;27:373–380
  33. Setaro J, Soufer R, Remetz M, Perlmutter R, Zarat B. Long-term outcome in patients with congestive heart failure and intact systolic left ventricular performance. Am J Cardiol. 1992;69:1212–1216
  34. Jais P, Takahashi A, Garrigue S, et al. Mid-term follow-up of endocardial biventricular pacing. PACE. 2000;23:1744–1747
  35. Hochleitner M, Hortnagl H, Ng C, Hortnagl H, Gschnitzer F, Zechmann W. Usefulness of physiologic dual-chamber pacing in drug-resistant idiopathic dilated cardiomyopathy. Am J Cardiol. 1990;66:198–202
  36. Falk R, Pollak A, Tandon P, Packer M. The effect of warfarin on prevalence of stroke in patients with severe heart failure. J Am Coll Cardiol. 1993;21(Suppl A):218A
  37. Griffith G, Stragnell R, Levinson D, Moore F, Ware A. A study of the beneficial effects of anticoagulant therapy in congestive heart failure. Ann Intern Med. 1952;867–887
  38. Mathew J, Hunsberger S, Fleg J, MsSherry F, Williford W, Yusuf S. Incidence, predictive factors, and prognostic significance of supraventricular tachyarrhythmias in congestive heart failure. Chest. 2000;118:914–922
  39. Remme W, Cleland J, DiLenarda A, et al. Carvedilol better protects against vascular events than metoprolol in heart failure: results from COMET. J Am Coll Cardiol. 2004;Suppl A:205A
  40. Ghose J, CHakraborty S, Mondal M, Bhandari B. Effect of vasodilator therapy on mortality in chronic congestive heart failure. J Assoc Phys India. 1993;41:269–271
  41. Cleland J, Findlay I, Jafri S, et al. The Warfarin/Aspirin Study in Heart failure (WASH): a randomized trial comparing antithrombotic strategies for patients with heart failure. Am Heart J. 2004;148:157–164
  42. Granger C, McMurray J, Yusuf S, et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: the CHARM-Alternative trial. Lancet. 2003;362:772–776
  43. Kjekshus J, Swedberg K. Enalapril for congestive heart failure. Am J Cardiol. 1989;63:26D–32D
  44. McMurray J, Ostergren J, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial. Lancet. 2003;362:767–771
  45. Pitt B, Zannad F, Remme W, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med. 1999;341:709–717
  46. Pitt B, Poole-Wilson P, Segal R, et al. Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial—the Losartan Heart Failure Survival Study ELITE II. Lancet. 2000;355:1582–1587
  47. Pfeffer M, Swedberg K, Granger C, et al. Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme. Lancet. 2003;362:759–766
  48. Waagstein F, Bristow M, Swedberg K, et al. Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy. Lancet. 1993;342:1441–1446
  49. Witt B, Brown J, Jacobsen S, et al. The risk of ischemic stroke in heart failure: a population-based study in Olmsted County, Minnesota. Am Heart J. 2006;152:102–109
  50. Graham SP. To anticoagulate or not to anticoagulate patients with cardiomyopathy. Cardiol Clin. 2001;19:605–615
  51. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials. [erratum appears in Arch Intern Med 1994;154:2254] Arch Intern Med. 1994;154:1449–1457
  52. Pulerwitz T, Rabbani LE, Pinney SP. A rationale for the use of anticoagulation in heart failure management. J Thromb Thrombol. 2004;17:87–93
  53. Sacco R. Pathogenesis, classification, and epidemiology of cerebrovascular disease. In:  Rowland L editors. Merrit's neurology. 10th ed.. Philadelphia, PA: Lippincott, Williams, and Wilkins; 2000;
  54. Hunt S, Baker D, Chin M, et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult. J Am Coll Cardiol. 2001;2101–2113
  55. Teo KK, Yusuf S, Pfeffer M, et al. Effects of long-term treatment with angiotensin-converting-enzyme inhibitors in the presence or absence of aspirin: a systematic review. [see comment] [erratum appears in Lancet 2003;361:90] Lancet. 2002;360:1037–1043
  56. Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. [see comment] [erratum appears in N Engl J Med 2000;342:1376] N Engl J Med. 2000;342:145–153
  57. Froom P, Melamed S, Kristal-Boneh E, Benbassat J, Ribak J. Healthy volunteer effect in industrial workers. J Clin Epidemiol. 1999;52:731–735

 Funded by grants AR30582, HL59205, and HL68765 from the Public Health Service, National Institutes of Health. Grant support used to fund data analysis.

PII: S1071-9164(07)00010-3

doi: 10.1016/j.cardfail.2007.01.009

Journal of Cardiac Failure
Volume 13, Issue 6 , Pages 489-496 , August 2007

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