nach oben

Erschienen in:

07.08.2023 | Original Communication

Left ventricular hypertrophy and left atrial size are associated with ischemic strokes among non-vitamin K antagonist oral anticoagulant users

verfasst von: Alvin S. Das, Elif Gökçal, Avia Abramovitz Fouks, Mitchell J. Horn, Robert W. Regenhardt, Anand Viswanathan, Aneesh B. Singhal, Lee H. Schwamm, Steven M. Greenberg, M. Edip Gurol

Erschienen in: Journal of Neurology | Ausgabe 11/2023

Einloggen, um Zugang zu erhalten

Abstract

Background

Ischemic strokes (IS) occurring in patients taking non-vitamin K antagonist oral anticoagulants (NOACs) are becoming increasingly more frequent. We aimed to determine the clinical, echocardiographic, and neuroimaging markers associated with developing IS in patients taking NOACs for atrial fibrillation.

Methods

From a quaternary care center, clinical/radiologic data were collected from consecutive NOAC users with IS and age-matched controls without IS. Brain MRIs were reviewed for markers of cerebral small vessel disease. Variables with significant differences between groups were entered into a multivariable regression model to determine predictors of IS. Among IS patients, a Cox regression analysis was constructed to determine predictors of IS recurrence during follow-up.

Results

112 patients with IS and 94 controls were included in the study. Variables significantly different between groups included apixaban use, dabigatran use, prior cerebrovascular events, hemoglobin A1c (HbA1c), left ventricular hypertrophy, left atrial volume index, and severe white matter hyperintensities. After multivariable adjustment, prior cerebrovascular events (aOR 23.86, 95% CI [6.02–94.48]), HbA1c levels (aOR 2.36, 95% CI [1.39–3.99]), left ventricular hypertrophy (aOR 2.73, 95% CI [1.11–6.71]) and left atrial volume index (aOR 1.05, 95% CI [1.01–1.08]) increased the risk of stroke, whereas apixaban use appeared to decrease the risk (aOR 0.38, 95% CI [0.16–0.92]). Malignancy was associated with IS recurrence (aHR 4.90, 95% CI [1.35–18.42]) after adjustment for age and chronic renal failure.

Conclusions

Prior cerebrovascular events, diabetes, left ventricular hypertrophy, and increased left atrial size are risk factors for developing an IS among NOAC users.

Nur mit Berechtigung zugänglich

January CT, Wann LS, Calkins H et al (2019) 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. J Am Coll Cardiol 74:104–132. https://doi.org/10.1016/j.jacc.2019.01.011CrossRefPubMed

Connolly SJ, Ezekowitz MD, Yusuf S et al (2009) Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361:1139–1151. https://doi.org/10.1056/NEJMoa0905561CrossRefPubMed

Diener H-C, Eikelboom J, Connolly SJ et al (2012) Apixaban versus aspirin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a predefined subgroup analysis from AVERROES, a randomised trial. Lancet Neurol 11:225–231. https://doi.org/10.1016/S1474-4422(12)70017-0CrossRefPubMed

Granger CB, Alexander JH, McMurray JJ et al (2011) Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 365:981–992. https://doi.org/10.1056/NEJMoa1107039CrossRefPubMed

Patel MR, Mahaffey KW, Garg J et al (2011) Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 365:883–891. https://doi.org/10.1056/NEJMoa1009638CrossRefPubMed

Shpak M, Ramakrishnan A, Nadasdy Z et al (2018) Higher incidence of ischemic stroke in patients taking novel oral anticoagulants. Stroke 49:2851–2856. https://doi.org/10.1161/STROKEAHA.118.022636CrossRefPubMed

Hylek EM, Go AS, Chang Y et al (2003) Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation. N Engl J Med 349:1019–1026. https://doi.org/10.1056/NEJMOA022913CrossRefPubMed

Cao C, Martinelli A, Spoelhof B et al (2017) In potential stroke patients on warfarin, the international normalized ratio predicts ischemia. Cerebrovasc Dis Extra 7:111. https://doi.org/10.1159/000478793CrossRefPubMedPubMedCentral

Lip GYH, Nieuwlaat R, Pisters R et al (2010) Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach. Chest 137:263–272. https://doi.org/10.1378/chest.09-1584CrossRefPubMed

10.

Das AS, Regenhardt RW, Vernooij MW et al (2019) Asymptomatic cerebral small vessel disease: insights from population-based studies. J Stroke 21:121–138. https://doi.org/10.5853/jos.2018.03608CrossRefPubMedPubMedCentral

11.

Hamatani Y, Ogawa H, Takabayashi K et al (2016) Left atrial enlargement is an independent predictor of stroke and systemic embolism in patients with non-valvular atrial fibrillation. Sci Rep 6:31042CrossRefPubMedPubMedCentral

12.

Rydén L, Sacuiu S, Wetterberg H et al (2021) Atrial fibrillation, stroke, and silent cerebrovascular disease. Neurology 97:e1608–e1619. https://doi.org/10.1212/WNL.0000000000012675CrossRefPubMedPubMedCentral

13.

Paciaroni M, Agnelli G, Caso V et al (2019) Causes and risk factors of cerebral ischemic events in patients with atrial fibrillation treated with non-vitamin K antagonist oral anticoagulants for stroke prevention. Stroke 50:2168–2174. https://doi.org/10.1161/STROKEAHA.119.025350CrossRefPubMed

14.

Nalichowski R, Keogh D, Chueh HC, Murphy SN (2006) Calculating the benefits of a research patient data repository. In: AMIA annual symposium proceedings. https://pubmed.ncbi.nlm.nih.gov/17238663/. Accessed 23 June 2021

15.

Das AS, Gökçal E, Regenhardt RW et al (2022) Clinical and neuroimaging risk factors associated with the development of intracerebral hemorrhage while taking direct oral anticoagulants. J Neurol 269:6589–6596. https://doi.org/10.1007/S00415-022-11333-2CrossRefPubMed

16.

van Swieten JC, Koudstaal PJ, Visser MC et al (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607CrossRefPubMed

17.

Adams HP Jr, Bendixen BH, Kappelle LJ et al (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24:35–41CrossRefPubMed

18.

Amarenco P, Labreuche J, Elbaz A et al (2006) Blood lipids in brain infarction subtypes. Cerebrovasc Dis 22:101–108. https://doi.org/10.1159/000093237CrossRefPubMed

19.

Mitsios JP, Ekinci EI, Mitsios GP et al (2018) Relationship between glycated hemoglobin and stroke risk: a systematic review and meta-analysis. J Am Heart Assoc 7:e007858. https://doi.org/10.1161/JAHA.117.007858CrossRefPubMedPubMedCentral

20.

Fanikos J, Burnett AE, Mahan CE, Dobesh PP (2017) Renal function considerations for stroke prevention in atrial fibrillation. Am J Med 130:1015–1023. https://doi.org/10.1016/J.AMJMED.2017.04.015CrossRefPubMed

21.

Lang RM, Badano LP, Mor-Avi V et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28:1-39.e14. https://doi.org/10.1016/j.echo.2014.10.003CrossRefPubMed

22.

Jiamsripong P, Honda T, Reuss CS et al (2008) Three methods for evaluation of left atrial volume. Eur J Echocardiogr 9:351–355. https://doi.org/10.1016/j.euje.2007.05.004CrossRefPubMed

23.

Silvestry FE, Cohen MS, Armsby LB et al (2015) Guidelines for the echocardiographic assessment of atrial septal defect and patent foramen ovale: from the American Society of Echocardiography and Society for Cardiac Angiography and Interventions. J Am Soc Echocardiogr 28:910–958. https://doi.org/10.1016/j.echo.2015.05.015CrossRefPubMed

24.

Wardlaw JM, Smith EE, Biessels GJ et al (2013) Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol 12:822–838. https://doi.org/10.1016/S1474-4422(13)70124-8CrossRefPubMedPubMedCentral

25.

Fazekas F, Kleinert R, Offenbacher H et al (1993) Pathologic correlates of incidental MRI white matter signal hyperintensities. Neurology 43:1683–1689. https://doi.org/10.1212/wnl.43.9.1683CrossRefPubMed

26.

Pasi M, Boulouis G, Fotiadis P et al (2017) Distribution of lacunes in cerebral amyloid angiopathy and hypertensive small vessel disease. Neurology 88:2162–2168. https://doi.org/10.1212/WNL.0000000000004007CrossRefPubMedPubMedCentral

27.

Charidimou A, Boulouis G, Pasi M et al (2017) MRI-visible perivascular spaces in cerebral amyloid angiopathy and hypertensive arteriopathy. Neurology 88:1157–1164. https://doi.org/10.1212/WNL.0000000000003746CrossRefPubMedPubMedCentral

28.

Greenberg SM, Vernooij MW, Cordonnier C et al (2009) Cerebral microbleeds: a guide to detection and interpretation. Lancet Neurol 8:165–174. https://doi.org/10.1016/S1474-4422(09)70013-4CrossRefPubMedPubMedCentral

29.

Charidimou A, Boulouis G, Roongpiboonsopit D et al (2017) Cortical superficial siderosis multifocality in cerebral amyloid angiopathy: a prospective study. Neurology 89:2128–2135. https://doi.org/10.1212/WNL.0000000000004665CrossRefPubMedPubMedCentral

30.

Staals J, Makin SD, Doubal FN et al (2014) Stroke subtype, vascular risk factors, and total MRI brain small-vessel disease burden. Neurology 83:1228–1234. https://doi.org/10.1212/WNL.0000000000000837CrossRefPubMedPubMedCentral

31.

Paciaroni M, Agnelli G, Ageno W et al (2010) Risk factors for cerebral ischemic events in patients with atrial fibrillation on warfarin for stroke prevention. Atherosclerosis 212:564–566. https://doi.org/10.1016/j.atherosclerosis.2010.06.016CrossRefPubMed

32.

Yao X, Abraham NS, Sangaralingham LR et al (2016) Effectiveness and safety of dabigatran, rivaroxaban, and apixaban versus warfarin in nonvalvular atrial fibrillation. J Am Heart Assoc 5:e003725. https://doi.org/10.1161/JAHA.116.003725CrossRefPubMedPubMedCentral

33.

Chan YH, See LC, Tu HT et al (2018) Efficacy and safety of apixaban, dabigatran, rivaroxaban, and warfarin in Asians with nonvalvular atrial fibrillation. J Am Heart Assoc 7:e008150. https://doi.org/10.1161/JAHA.117.008150CrossRefPubMedPubMedCentral

34.

Fralick M, Colacci M, Schneeweiss S et al (2020) Effectiveness and safety of apixaban compared with rivaroxaban for patients with atrial fibrillation in routine practice: a cohort study. Ann Intern Med 172:463–473. https://doi.org/10.7326/M19-2522CrossRefPubMed

35.

Lip GYH, Keshishian A, Kang A et al (2022) Effectiveness and safety of oral anticoagulants in non-valvular atrial fibrillation patients with prior bleeding events: a retrospective analysis of administrative claims databases. J Thromb Thrombolysis 54:33. https://doi.org/10.1007/S11239-022-02660-2CrossRefPubMedPubMedCentral

36.

Paciaroni M, Agnelli G, Falocci N et al (2016) Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation: findings from the RAF study. J Neurol 263:231–237. https://doi.org/10.1007/S00415-015-7957-3CrossRefPubMed

37.

Yaghi S, Moon YP, Mora-McLaughlin C et al (2015) Left atrial enlargement and stroke recurrence. Stroke 46:1488–1493. https://doi.org/10.1161/STROKEAHA.115.008711CrossRefPubMedPubMedCentral

38.

Xu Y, Zhao L, Zhang L et al (2020) Left atrial enlargement and the risk of stroke: a meta-analysis of prospective cohort studies. Front Neurol 11:26. https://doi.org/10.3389/FNEUR.2020.00026CrossRefPubMedPubMedCentral

39.

Gurol ME (2018) Nonpharmacological management of atrial fibrillation in patients at high intracranial hemorrhage risk. Stroke 49:247–254. https://doi.org/10.1161/STROKEAHA.117.017081CrossRefPubMed

40.

Bots ML, Nikitin Y, Salonen JT et al (2002) Left ventricular hypertrophy and risk of fatal and non-fatal stroke. EUROSTROKE: a collaborative study among research centres in Europe. J Epidemiol Community Health 56:i8. https://doi.org/10.1136/JECH.56.SUPPL_1.I8CrossRefPubMedPubMedCentral

41.

Wang S, Xue H, Zou Y et al (2014) Left ventricular hypertrophy, abnormal ventricular geometry and relative wall thickness are associated with increased risk of stroke in hypertensive patients among the Han Chinese. Hypertens Res 37:870–874. https://doi.org/10.1038/HR.2014.88CrossRefPubMed

42.

Verdecchia P, Porcellati C, Reboldi G et al (2001) Left ventricular hypertrophy as an independent predictor of acute cerebrovascular events in essential hypertension. Circulation 104:2039–2044. https://doi.org/10.1161/HC4201.097944CrossRefPubMed

43.

Castilla-Guerra L, Fernández-Moreno MDC, Alvarez-Suero J, Gonzalez A (2012) Echocardiographic assessment of hypertensive left ventricular hypertrophy in patients with acute ischemic stroke or transient ischemic attack. J Stroke Cerebrovasc Dis 21:745–748. https://doi.org/10.1016/J.JSTROKECEREBROVASDIS.2011.03.012CrossRefPubMed

44.

Di Tullio MR, Zwas DR, Sacco RL et al (2003) Left ventricular mass and geometry and the risk of ischemic stroke. Stroke 34:2380. https://doi.org/10.1161/01.STR.0000089680.77236.60CrossRefPubMedPubMedCentral

45.

Bluemke DA, Kronmal RA, Lima JAC et al (2008) The relationship of left ventricular mass and geometry to incident cardiovascular events: the MESA (Multi-Ethnic Study of Atherosclerosis) study. J Am Coll Cardiol 52:2148–2155. https://doi.org/10.1016/J.JACC.2008.09.014CrossRefPubMedPubMedCentral

46.

Houghton JL, Frank MJ, Carr AA et al (1990) Relations among impaired coronary flow reserve, left ventricular hypertrophy and thallium perfusion defects in hypertensive patients without obstructive coronary artery disease. J Am Coll Cardiol 15:43–51. https://doi.org/10.1016/0735-1097(90)90173-MCrossRefPubMed

47.

Tadic M, Cuspidi C (2014) Do we understand the relationship between left ventricular structural remodeling and stroke in arterial hypertension? Hypertens Res 379(37):801–802. https://doi.org/10.1038/hr.2014.106CrossRef

48.

Zand R, Shahjouei S, Tsivgoulis G et al (2018) Cerebral microbleeds are associated with higher mortality among ischemic stroke patients. J Stroke Cerebrovasc Dis 27:3036–3042. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.06.037CrossRefPubMed

Titel: Left ventricular hypertrophy and left atrial size are associated with ischemic strokes among non-vitamin K antagonist oral anticoagulant users
verfasst von: Alvin S. Das
Elif Gökçal
Avia Abramovitz Fouks
Mitchell J. Horn
Robert W. Regenhardt
Anand Viswanathan
Aneesh B. Singhal
Lee H. Schwamm
Steven M. Greenberg
M. Edip Gurol
Publikationsdatum: 07.08.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Journal of Neurology / Ausgabe 11/2023
Print ISSN: 0340-5354
Elektronische ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-023-11916-7

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Neurologie

Demenzkranke durch Antipsychotika vielfach gefährdet

Demenz Nachrichten

Der Einsatz von Antipsychotika gegen psychische und Verhaltenssymptome in Zusammenhang mit Demenzerkrankungen erfordert eine sorgfältige Nutzen-Risiken-Abwägung. Neuen Erkenntnissen zufolge sind auf der Risikoseite weitere schwerwiegende Ereignisse zu berücksichtigen.

Nicht Creutzfeldt Jakob, sondern Abführtee-Vergiftung

29.05.2024 Hyponatriämie Nachrichten

Eine ältere Frau trinkt regelmäßig Sennesblättertee gegen ihre Verstopfung. Der scheint plötzlich gut zu wirken. Auf Durchfall und Erbrechen folgt allerdings eine Hyponatriämie. Nach deren Korrektur kommt es plötzlich zu progredienten Kognitions- und Verhaltensstörungen.

Schutz der Synapsen bei Alzheimer

29.05.2024 Morbus Alzheimer Nachrichten

Mit einem Neurotrophin-Rezeptor-Modulator lässt sich möglicherweise eine bestehende Alzheimerdemenz etwas abschwächen: Erste Phase-2-Daten deuten auf einen verbesserten Synapsenschutz.

Sozialer Aufstieg verringert Demenzgefahr

24.05.2024 Demenz Nachrichten

Ein hohes soziales Niveau ist mit die beste Versicherung gegen eine Demenz. Noch geringer ist das Demenzrisiko für Menschen, die sozial aufsteigen: Sie gewinnen fast zwei demenzfreie Lebensjahre. Umgekehrt steigt die Demenzgefahr beim sozialen Abstieg.

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Background

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 11/2023

Correction to: Daytime sleepiness and sleep quality in Charcot–Marie–Tooth disease

Non-pharmacological and drug treatment of autonomic dysfunction in multiple system atrophy: current status and future directions

Crossing the border between epileptic and vascular pathology: a report of CACNA1A-related treatment-resistant hemiplegic migraine

Cortical thickness and cognition in older people with multiple sclerosis

Menière’s disease with migraine, Menière’s disease without migraine and Vestibular migraine: clinical differences