Introduction: The time course and risk of hemorrhagic and ischemic stroke following left ventricular assist device (LVAD) placement is not well described.
Hypothesis: Ischemic and hemorrhagic stroke are major causes of mortality following LVAD placement.
Methods: Prospectively collected data of Heartmate II (N=335) and Heartware (N=70) LVAD patients from a single center were reviewed from 10/21/2004-5/19/2015. Patients were followed until transplant or death. Predictors of ischemic and hemorrhagic stroke (ICH, SAH, SDH) occurring during hospitalization for LVAD placement (early stroke) or in follow-up (late stroke) were assessed using Chi-squared or Mann-Whitney U tests. The association of stroke and mortality was assessed using multivariable logistic regression analysis.
Results: Of 405 patients, stroke occurred in 69 (17%). Early ischemic and hemorrhagic stroke occurred in 18 (4.4%) and 11 (2.7%) patients, respectively. Late ischemic and hemorrhagic stroke occurred in 25 (6.2%) and 29 (7.2%) patients, respectively and 11 (3%) had more than one stroke. ICH was the most common type of hemorrhagic stroke (N=23). History of implanted cardioverter defibrillator, tobacco use, poor NYHA class and hypertension post-LVAD significantly predicted ischemic stroke, while history of hypertension and arrhythmia predicted hemorrhagic stroke (all P<0.05). Stroke was the leading primary cause of death in 17% of LVAD patients (second only to multi-system organ failure [21%]). Most deaths were related to late ischemic stroke (N=9/150, 6%), or late hemorrhagic stroke (N=15/150, 10%), while only 2 (1%) died from early stroke. After adjusting for age, NYHA class, and LVAD type, late ischemic stroke (adjusted odds ratio [aOR] 8.8, 95% CI 3.3-23.5, P<0.0001) and late hemorrhagic stroke (aOR 9.7, 95% CI 4.0-23.4, P<0.0001) predicted death, while early ischemic or hemorrhagic stroke did not.
Conclusions: Stroke is a leading cause of death in LVAD patients. Late ischemic and hemorrhagic stroke have a greater impact on mortality than early stroke. Management of risk factors, such as hypertension post LVAD, may reduce stroke and mortality rates.