Background: According to current research, heart failure can promote thrombus formation and increase stroke risk even in patients in sinus rhythm. Although there is currently no recommendation for this primarily prophylactic treatment, some studies have suggested that the initiation of systemic oral anticoagulation may reduce the incidence of stroke in this cohort. The aim of this study is to explore the prevalence and incidence of stroke, develop a stroke-risk model, and investigate the benefits of therapeutic anticoagulation in this population.
Methods: This retrospective, longitudinal observational study analysed 716 cardiomyopathy patients with an implanted cardiac device (pacemaker, ICD or CRT-P/-D) treated at Heidelberg University Hospital. Patients with a history of atrial flutter, atrial fibrillation or indication for long-term usage of therapeutic anticoagulation during the observation period were excluded. Clinical, diagnostic and laboratory parameters potentially relevant for the occurrence of stroke are integrated. The primary endpoint of the study is the occurrence of stroke or TIA, whereas the secondary endpoints are other thromboembolic events, bleeding, cardiovascular or all-cause mortality.
Preliminary Results: Over a median follow-up period of 2.5 years, 26 patients reached the primary endpoint. Statistical analysis showed no significant association between stroke occurrence and cardiomyopathy type, LVEF and sex (p=0.59, p=0.67 and p=0.93, respectively). However, older age and elevated troponin levels were associated with higher stroke occurrence (p=0.0061 and p=0.04, respectively) and all-cause mortality (p=0.0038 and p<0.0001, respectively). As observed in patients with atrial fibrillation, a higher CHA₂DS₂-VASc score was associated with an increased risk of stroke (p<0.0001). There was also a significant correlation between CHA₂DS₂-VASc score and all-cause mortality (p=0.01). Additionally, a significant correlation was observed between all-cause mortality and cardiomyopathy type (p=0.0036). Survival rates were lowest in patients with amyloidosis, followed by those with hypertrophic cardiomyopathy and ischemic cardiomyopathy, while patients with dilated cardiomyopathy showed the highest survival rates. To assess the bleeding risk, the HAS-BLED score was included. A higher HAS-BLED score was significantly associated with increased stroke occurrence and all-cause mortality (p=0.038 and p=0.00052, respectively).
Preliminary Conclusions: Parameters such as age, CHA₂DS₂-VASc score and troponin levels may be crucial for the stroke risk stratification in cardiomyopathy patients in sinus rhythm. The HAS-BLED score also correlated with stroke and all-cause mortality, suggesting broader prognostic utility, especially in this cohort in which anticoagulation may be considered for stroke prevention. Furthermore, the variation in survival across cardiomyopathy subtypes and CHA₂DS₂-VASc score levels underline the importance of individualized risk assessment. Our aim is to develop a risk model that accurately identifies high-risk patients within this cohort, thereby guiding clinical decisions on anticoagulation therapy to prevent stroke while managing bleeding risk effectively.
