Factors Associated with Incident Ischemic Stroke in Hospitalized Heart Failure Patients: A Pilot Study

Abstract

Stroke is sometimes seen in patients with congestive heart failure (CHF). The factors that best predict incident stroke in hospitalized CHF patients are not well known. We performed this pilot study to explore the clinical markers of incident stroke in CHF patients. We studied 111 hospitalized patients with CHF (mean age, 67 ± 11 years). Ambulatory blood pressure (BP) monitoring, blood tests, and echocardiography were performed in these patients just before they left the hospital, and all cardiovascular events during the study period were followed for an average of 18 ± 9 months. Cox regression analysis was performed to explore the predictors of incident stroke using age, sex, body mass index (BMI), casual and ambulatory systolic BP (SBP), and brain-type natriuretic peptide (BNP). There were 10 stroke events (9%) during the follow-up period. The stroke group had higher nocturnal SBP and plasma BNP levels than the non-stroke group. With Cox regression analysis, both nocturnal SBP and BNP were significant predictors of incident stroke independent of other covariates. When nocturnal BP of 120 mmHg and BNP of 600 pg/mL (75th percentile) were used as cutoffs, nocturnal SBP ≥ 120 mmHg was associated with a 7-fold increase in the risk of incident stroke, while BNP ≥ 600 pg/mL was associated with a 46.6-fold increase. However, abnormal circadian BP patterns were not associated with incident stroke. In this pilot study, elevated nocturnal BP and high plasma BNP just before patients left the hospital were significant predictors of stroke events in CHF patients. Further study is needed to confirm this hypothesis. (Hypertens Res 2008; 31: 289-294)

Heart failure may be associated with the onset of ischemic stroke with atrial fibrillation

“…Abnormalities of hemostasis, blood constituents, and endothelial dysfunction are considered the mechanism of ischemic stroke onset in patients with heart failure [16]. Previous report demonstrated that high plasma BNP was independent predictor of stroke event in hospitalized congestive heart failure patients [17]. Therefore, congestive heart failure may induce ischemic stroke in patients with AF.…”

Plasma Brain Natriuretic Peptide Can be a Biological Marker to Distinguish Cardioembolic Stroke from Other Stroke Types in Acute Ischemic Stroke

“…Therefore, congestive heart failure may induce a cardioembolic stroke. A previous report demonstrated that high plasma BNP was an independent predictor of a stroke event in hospitalized congestive heart failure patients (14). Moreover (17), hypertrophic cardiomyopathy (18), pulmonary embolism (19), and Takotsubo cardiomyopathy (20) (22,23).…”

Clinical Significance and Therapeutic Implication of Nocturnal Hypertension: Relationship between Nighttime Blood Pressure and Quality of Sleep

“…Many retrospective studies have been conducted to identify the effect of nocturnal hypertension and non-dipping patterns on its clinical implications. Nocturnal hypertension is a risk factor for target organ damage for the brain, heart, kidney, and large and small arteries and for all CVD events including both hemorrhagic and ischemic stroke, CHD, HF (especially with HF with preserved ejection fraction), CKD, and sudden cardiac death, independently of clinic BP, in general populations and hypertensive patients 6)20)50)51). In the PAMELA study, the risk of cardiovascular death for each 10 mmHg increase of systolic BP progressively increased from office to home, day, 24-hour to night BP values 52).…”